Nicholas Winterton: I strongly support the idea that GPs' surgeries should open for longer. In the main, GPs are popular with their patients, are trusted and know the details of the conditions of those who are on their panel. However, I am reserved about the Government's proposal to open polyclinics, which I believe would be an expensive duplication of GPs' services and undermine the position of GP surgeries. Will not the Government reconsider their proposal and perhaps try to work through GPs to extend services, so that the services that people want are available in the evening and at weekends?

Anne McIntosh: Does the Minister agree that it is not so much the hours that GPs are available that are important, but the services that each GP practice offers? Is he aware that the White Paper on pharmacy proposed taking away the ability of GP practices in market towns such as Thirsk to dispense? That will reduce the services that they can offer. There is no point in the Minister of State, the right hon. Member for Bristol, South (Dawn Primarolo) shaking her head. I met representatives of GP practices and I also declare an interest in that I am a GP's daughter and a GP's sister. We want to keep dispensing services in rural practices.

Mark Simmonds: It seems extraordinary that the Minister is claiming credit for the Government reinstating a service that they removed three or four years ago. I want to press him further on the point that my hon. Friend the Member for Vale of York (Miss McIntosh) made. She was absolutely right to say that access to GPs and primary care is about more than just opening hours. Will the Minister acknowledge that the proposals in the pharmacy White Paper that potentially remove the right of GP practices to dispense are causing immense concern both to service providers and, more importantly, to their patients? In consultation with the Minister responsible—the Minister of State, Department of Health, the right hon. Member for Bristol, South (Dawn Primarolo), who is whispering in his ear—will he confirm that there will be no changes to the control of entry regime without a full, published, comprehensive and genuine consultation, which takes into account the needs of communities that use GP dispensing services and pays particular regard to the proposed changes in the White Paper to the imposed distance criteria?

Dawn Primarolo: I had a meeting with representatives of the Anthony Nolan Trust recently and I should say to the hon. Lady that the NHS has access through the international bone marrow registry and others to something like 10 million samples, and that 72 per cent. of the matches in cord blood in the UK are provided internationally. There are two separate issues here: the first is treatment now and the second is research. The Anthony Nolan Trust is looking particularly into the issue of treatment now. The NHS cord blood bank is currently undertaking a review, which will report to me later this year about how to ensure a greater percentage of matches. We have already put in extra money, particularly for collection in respect of black, minority and ethnic communities. Over and above that, the Anthony Nolan Trust is looking into the development of its services, and I have said that it is crucial that developments at both the NHS blood bank and the Anthony Nolan Trust take place in partnership to ensure that we maximise the benefits for UK patients. That is what we intend to do.

Claire Curtis-Thomas: As my right hon. Friend will know, back in 1997, the construction industry was on the point of collapse. I am proud of the health service's commitments to new hospitals and clinics, which has revitalised the industry, but I want to ensure that its significant investment leads to training opportunities for young people as part of their apprenticeship programmes. What is my right hon. Friend doing to ensure that those public-sector funds are spent on delivering better skills and better-qualified young people?

Alan Johnson: My hon. Friend has been a champion of apprenticeships. I think she will accept that what the Department is doing is exemplary in Whitehall terms. Indeed, I hope she will accept that we are "Top of the Pops" in terms of the number of apprentices we are recruiting.
	As for what we are doing in the country more generally, my right hon. Friend the Secretary of State for Innovation, Universities and Skills is running an integrated project to establish how we can use the huge public-sector investments that we are making in, for instance, hospital-building programmes to ensure that apprenticeships are provided in the construction industry, and also in education, so that we do not waste the valuable opportunity provided by our capital investment to increase the number of apprentices again. It needs to be raised to the level suggested in the Leitch review by 2015.

Ivan Lewis: I pay tribute to my right hon. Friend for the work that he did in the House in championing the needs of disabled children and their families, as a result of which we are investing an unprecedented amount to support those families—and so we should.
	The money from the Department for Children, Schools and Families is ring-fenced, and amounts to £370 million over three years. In the autumn of this year, the Department of Health will announce the overall sum that we will invest in child health over the next three years. It will include a specific figure to be put into primary care trust baselines to increase support for children with special needs and provide short breaks and support for children with palliative-care needs. It is crucial, in all parts of the United Kingdom, for us to prioritise the needs of disabled children and their families, and to ensure that the money allocated for the purpose is spent on improving their quality of life.

Ivan Lewis: May I say to my good friend that as well as the long-term review, we have, from April, been introducing a transformation programme in every local authority area, supported by half a billion pounds of reform money over three years? We will soon be publishing the first ever national dementia strategy and end-of-life strategy; we have announced the extension of our "Dignity in Care" campaign; the Secretary of State has announced a new package of preventive health measures specifically to support older people; we are extending the Human Rights Act 1998 to publicly funded residents of private care homes; and we have announced a new 10-year strategy to support carers. I am not sure that the hon. Gentleman's party has anything else to offer on this issue.

Karen Buck: I beg to move,
	That leave be given to bring in a Bill to require local authorities to collate and publish specified social, economic and other data on an annual basis; and for connected purposes.
	The debate about social inequality is beset by stereotypes and simplification. Sometimes stereotypes give us an indication of the truth, but they frequently conceal more than they reveal. So, we hear a lot about the north-south divide, and unemployment and incapacity benefit figures are frequently portrayed exclusively in terms of decayed former industrial communities in the north or in the Welsh valleys. Sometimes Tower Hamlets is contrasted with the Royal Borough of Kensington and Chelsea in what is frequently described as a tale of two cities, revealing the stark divide in average incomes, house prices and life expectancy.
	Such attention is broadly welcome because it highlights the continuing extent—and in some ways the worsening or intensification—of the toxin of inequality. It is even more corrosive than poverty, in its own insidious way, as has been so well documented by academics such as Richard Wilkinson. Inequality damages health, undermines community cohesion and is now understood to be more closely correlated with crime than poverty itself.
	Inequality is poorly understood. Last year's report for the Joseph Rowntree Foundation confirmed that people's knowledge about inequality is limited, and attitudes are complex, ambiguous and apparently contradictory. In turn, policy makers know little about how the perceptions people have are formed, or changed. We could simply choose to ignore the ramifications of inequality, precisely because public attitudes are complex and contradictory. But by doing so, we would be turning our backs on a very real problem. Over the last 20 years a consistently large majority of people have considered the gap between rich and poor to be too large, and only a small minority of people feel that the Government are doing too much to address the problem.
	My Bill is intended to make a small contribution to increasing awareness and understanding of social inequality. I seek broadly to mirror the important work done by primary care trusts in their annual public health reports, which have come into their own in recent years as an essential source of data about health inequalities. By requiring all local authorities to produce an annual audit, based on a core basket of indicators, I would hope to achieve three things. First, I would like to get beyond stereotypes, whether of the north-south divide kind, or the Tower Hamlets versus Kensington and Chelsea variety. The reality is far more complex than such stereotypes would have us believe and generalisations limit understanding, not deepen it.
	Secondly, I hope that the process of producing and publishing annual audits would generate interest and debate among local policy makers, the media and others, precisely because the information would be local. Of course, there are no guarantees that such interest would sharpen the focus on deprivation and inequality, but it would certainly offer communities a set of tools to hold policy makers to account. That is certainly the experience of PCTs and public health reports in recent years.
	Thirdly, requiring a core set of indicators that apply to all authorities would enable more specific comparisons between small areas across the country. It would also promote a wider and more interesting debate nationally about the causes of inequality and social deprivation.
	I confess to a personal stake in this issue. The local councils that make up my constituency—Westminster and Kensington and Chelsea—consistently come near to the top of national league tables for wealth and income. The prosperity of Knightsbridge, Belgravia and Chelsea, where some councillors think that international bankers constitute a "hard to reach group", masks the fact that, as recent reports have confirmed, the Mozart estate in Queen's Park in my constituency is the most deprived neighbourhood in the whole country, and Westbourne ward has the country's highest proportion of children in workless households. But I—and my colleagues in other areas with generally affluent average figures—struggle to get the implications of that understood locally and nationally, and families and pensioners living in poor neighbourhoods in such areas lose out in consequence.
	Local authority social equality audits would be based on existing sources of data. I am not seeking to saddle councils with major new duties in collecting and analysing information, but to bring the vast array of data already buried in the vaults—locally and nationally—blinking into the light.
	What would be included? Obviously, I would want short profiles of all neighbourhoods, which currently stay anonymously labelled as "super output areas" buried in the Office for National Statistics. Which are the most prosperous areas and which the poorest? We already have information on employment levels, and the number of children in workless households—that is, families surviving on less than £10 per day for fuel, food, clothing and treats. I would want to include data that exist but are unpublished, collected in school information profiles. League tables offer us information on key stage results and useful, though poorly understood, contextualised added value, but they should be complemented by the information that we hold on all schools about free school meal entitlements and other proxies for deprivation.
	Harsh words about school performance miss the target when the breathtaking variations we see in school intake receive so little attention. It would also be useful to include information on benefits and services delivered by local authorities, including housing benefit and take-up of child care and out-of-school services. That would enable more informed discussions about local welfare-to-work policies, the impact of local authority charging policies and so on.
	Audits would not be exclusively about ward or neighbourhood data, either, but would include local authority rankings on key deprivation indicators and proxies for deprivation, such as substandard housing, overcrowding and homelessness. Of course, as has proved to be the case with PCT public health reports, it would be good to see themes emerge and to see priorities set from year to year between different communities that reflect local circumstances so that audits become dynamic tools, complementing and informing local area agreements and council decision-making processes.
	Information does not by itself make wrongs right. Information can be powerful and can do harm if abused or used partially or selectively, yet the alternative is far worse. We should no more be ignorant about poverty and inequality than we should be about climate change or any of the other great issues of our time. By offering local communities, policy makers and the media clearly presented and comparative data, we might not get all of the right answers but we might at least ensure that people are asking the right questions.
	 Question put and agreed to.
	Bill ordered to be brought in by Ms Karen Buck, Mr. Iain Duncan Smith, Mr. David Blunkett, Mr. Frank Field, Simon Hughes, Fiona Mactaggart, Mr. Gary Streeter, Martin Salter, Mr. Terry Rooney, Clive Efford, Lyn Brown and John Battle.

Shona McIsaac: I ask the hon. Gentleman to follow up what was said by my right hon. Friend the Member for Scunthorpe (Mr. Morley). I represent the rural part of north Lincolnshire. We will get a new clinic in north Lincolnshire, but the PCT has told us that that is a local decision to meet local need, and not one rural GP practice will close as a result of these plans. So why is the hon. Gentleman and his hon. Friends scaremongering to extent that my residents think that their practices will close?

Alan Johnson: The hon. Gentleman has twice mentioned my constituency. What Hull is doing of its own volition is going out to consultation at the moment, and the proposal is in excess of the proposals for the new centres that will come to under-doctored areas and in excess of the GP-led health centre that we are putting into Hull. It is consulting on three additional health centres to deal with three problems: first, a preponderance of single-handed GPs; secondly, facilities and services that do not even meet the Disability Discrimination Act 2005; and thirdly, the fact that it has no women doctors whatsoever. So the PCT has gone out to consult the people of Hull, quite separately from what we are doing nationally, to seek to address those problems, and so it should.

Andrew Lansley: I am grateful to my hon. Friend, who has gone to the heart of the issue. At the moment, the Government require PCTs to publish memorandums of information before in effect tendering for the new polyclinics. We have seen the tender documents from 58 PCTs, which identify 608 GP surgeries in proximity to proposed polyclinic locations. Because the Government have insisted that the new polyclinics should register patients, the local practices identified in those documents will see their patient lists undermined, some of them potentially fatally.
	The Secretary of State has said that no GP surgery will be closed as a consequence of opening polyclinics, but how can that be true? The Government amendment does not refer to the polyclinics proposal for London, which we should address for a second. The Prime Minister got up at the Dispatch Box and said that there would be 150 polyclinics, that each polyclinic would have 25 GPs and that each polyclinic would serve 50,000 people. The consequence of that would be the closure of more than 70 per cent. of existing GP surgeries in London.
	Documents from half the PCTs refer to 600 GP surgeries in proximity to potential polyclinics. If the polyclinics are not additional and the GPs in them are the same GPs who currently work in their own surgeries—or, for that matter, salaried doctors in PCTs—then a number of surgeries will have to close. That was the clear implication of the Government's proposals for London. If that is not the case and the GPs are genuinely additional GPs in additional GP practices, where will the money come from? We have done that calculation, too. If the Secretary of State is to be believed and the provision is all additional, the cost of that number of GPs in that number of surgeries would be £1.6 billion a year. However, the Government have allocated £250 million over three years, so the situation simply does not add up. One of two things must be true. Either the GPs will be moved and the practices will be moved from their present locations into larger polyclinics, or additional services will be provided and additional costs will be incurred. The Government have not answered the question of which one of those two things it will be.

Karen Buck: In my PCT, the thinking concerns creating a polyclinic based on a hospital. That would reduce inappropriate accident and emergency attendances by people who are not registered with doctors, which hammers the hon. Gentleman's argument that there is a one-size-fits-all solution. Is it not true that in 1981 the Acheson report addressed the issue of single-handed practices particularly in London, where single-handed practices were over-represented? For 16 years, Conservative Governments made progress—not enough in my view—on reducing single-handed practices. Although there is good practice in some single-handed practices, by and large the quality of care is not as good as that provided by other practices. Is the hon. Gentleman saying that his party stands four-square behind all single-handed practices, regardless of the quality of care?

Andrew Lansley: I agree with my hon. Friend.  Pulse recently looked at the proposals in respect of PCTs, and only a tiny proportion of those that it looked at had been subject to even a semblance of a public consultation. The reason is precisely the same as the reason that my hon. Friend gave: the Government are determined that the proposal should not be subject to scrutiny. Why? Because it will not stand up to that scrutiny, it is not locally determined, it does not arise out of the needs and circumstances of the area and, on the quality of care that will be provided, it is not even evidence-based.

Andrew Lansley: No, I shall not give way.
	The hon. Member for Regent's Park and Kensington, North was quite right to talk about London earlier, but it is important to understand that, far beyond that, there are considerable implications in rural areas. My hon. Friend the Member for Scarborough and Whitby (Mr. Goodwill), and my hon. Friend the Member for Beverley and Holderness (Mr. Stuart) in the East Riding, made it clear that there are rural areas where spending such money, so that a polyclinic is established in a place that is already well doctored, is not only wasteful of resources and prejudicial to the GP practices in the area, but, if it threatens other surgeries, could have serious implications for access.
	We have done the calculation on access to GP surgeries, and NHS London made a calculation in its consultation document. It says that it has done high-level modelling, meaning that people in London will be on average only 1.5 miles away from their GP surgery. That is quite interesting, because NHS London did not go on to say that, currently, people in London are on average just half a mile away from their GP surgery. So when the Secretary of State says that he is perfectly willing to campaign on the issue, perhaps he would like to tell all the people of London that the distance to their GP surgery will triple. It is quite clear: we have done the calculation and NHS London said that the distance would be 1.5 miles.  [ Interruption. ] It is quite clear. It is a good one. Don't you worry, it is.  [ Interruption. ] Actually, the Ministers should know that the distance will triple in Hull and in Exeter.
	In places such as North Cornwall, the distance to a GP would more than triple, rising to more than 9 miles on average. The Government are parading their belief that they can improve access to primary care, but nobody, anywhere in the country, will be able to believe the Government's arguments if their access to a local surgery would be so prejudiced. There is an enormous difference in London between going half a mile and going a mile and a half. Someone who is elderly, vulnerable, frail or a mother with children, without access to a car, becomes reliant on public transport. In rural areas, access to public transport over many of these distances is difficult to contemplate.

Alan Johnson: I beg to move, To leave out from "House" to end and to add instead thereof:
	"welcomes the Government's support for primary care and proposals to invest £250 million in 113 new GP practices in the most deprived communities and 152 new state-of-the-art GP-led health centres open from 8 a.m. to 8 p.m., seven days a week, in every part of the country; notes that these centres will offer a wide range of health services including pre-bookable GP appointments and walk-in services for registered and non-registered patients; recognises that the exact format and location of each GP-led centre will be decided locally in consultation with patients; notes that GPs will not be forced to work in the new GP-led centres and where that is the case patients will still be able to remain registered with their GPs at their existing location and premises; acknowledges that the expansion of primary care is essential if the overall health of the population is to improve, and inequalities in health are to be addressed; and welcomes plans to ensure enhanced primary care services are capable of meeting the new challenges facing the NHS including tackling lifestyle diseases such as obesity and through more effective screening programmes for the general population."
	We are delighted that the hon. Member for South Cambridgeshire (Mr. Lansley) has used up another of his party's Opposition day debates to allow us to reiterate our commitment to primary care, set out our record of investment and reform, and explain in detail our exciting plans to expand capacity in primary care.
	No previous Government have more clearly demonstrated their commitment to primary care and those who work in it. Let us examine the record since 1997: investment in primary care has more than doubled; there are more than 5,000 more GPs and more than 4,400 more practice nurses; GP pay has increased by around 55 per cent. in real terms; GP hours have reduced by 17 per cent., and the time spent on each patient is up by 50 per cent. That is hardly the record of a Government who are hostile to the role of primary care in the NHS.
	I want to set out as clearly as possible exactly what the Government propose throughout the country, what the NHS is seeking to do in London, and to mention briefly other separate developments that clinicians, patients and managers in local PCT areas, including—I am pleased to say—Hull, are leading.
	Let me begin by stating firmly what we do not propose. According to the BMA and its political wing opposite, the Government have not one but three evil ulterior motives: to privatise primary care by allowing companies such as Boots to run GP services; to nationalise primary care by making GPs state employees; and to destroy family practices by breaking the GP-patient link.

Jacqui Lait: If the footfall of a centralised primary care centre is 50,000 people, that adds up to about 50 per cent. of all the GP practices in any one constituency. As a south-east London MP, I should be grateful if the Secretary of State could say whether he is seriously proposing that 50 per cent. of our constituents go to one place for their primary care?

Alan Johnson: The total cost is estimated at around £150 million, which will be money well spent and a crucial investment in improving the situation in London.
	The term polyclinic has been used in London to describe a range of models that allow primary and some secondary care services, such as diagnostics, to be available in each local community, reducing travelling time and making services more convenient for patients. In some cases, that may involve bringing services together under one roof. In other cases, as my right hon. Friend the Member for Enfield, North (Joan Ryan) mentioned—this is a specific option that is part of the London proposals—it involves having a network of GP practices linked to a hub that provides more specialist services. Both of those are available in London.
	Interestingly, in the one part of the country where polyclinics are being proposed, Conservative politicians support those proposals, as, indeed, do the public. Every local authority overview and scrutiny committee, including those that are Tory-led, backs the exciting plans to resolve NHS problems in the capital—problems that probably should have been dealt with 20 or 30 years ago.

Clive Efford: In my constituency, we are about to rebuild a new local hospital which will be a 24/7, GP-led urgent care centre with 40 respite beds and diagnostic services that re to be brought right into the heart of our community in Eltham. The hon. Member for South Cambridgeshire (Mr. Lansley) has proposed that any vested interests in the local health economy could scupper that in the face of widespread local support for the scheme. That is not bringing the service back to local people; it is taking it away from them and putting it in the hands of vested interests.

Alan Johnson: It is absolutely the case that we are saying that in the interests of greater capacity, greater patient choice and the public being able to access primary care, this is not a zero-sum game. There will be a greater need to access primary care in the future, particularly with the plans that we have for prevention being as important as diagnosis and cure, and there must be one of these centres in each location.
	I have set out the three conditions. Beyond those, it is a matter for the local GPs and the PCT to discuss exactly how the service is provided.

Alan Johnson: I would tell those GPs that this is not the only investment being made in primary care. About half a billion pounds is going into primary care this year from one source or another. In Sunderland, as well as in my city of Hull, GPs will have their own plans, but we will ensure that nowhere in the country is there a single patient who cannot gain access to primary care seven days a week, 365 days a year, between 8 am and 8 pm. God forbid that I should make the link between Newcastle and Sunderland, but people who work in Newcastle and live in Sunderland will now be able to go to a GP-led health centre in Newcastle. This is about patient convenience and patient choice.

Alan Johnson: It is stated that the Tories claim that 608 practices may close in 58 PCTs.  [Interruption.] Well, I apologise for initially saying "will" instead of "may". Also, the procurement guidance that was "discovered" hidden away on our website was actually launched by Ministers in December at a public meeting.
	Barnsley is cited as one of the Conservatives' examples; it is said that, because there are all these GP surgeries around the area where the GP-led health centre will be placed, somehow they will all close. However, my hon. Friend the Member for Barnsley, Central (Mr. Illsley) is absolutely right. Barnsley has 49.3 GPs and 25.4 nurses per head of population and all the resultant health problems, while Cambridgeshire—the hon. Gentleman's part of the world—has 74.6 GPs and twice as many nurses per head of population. That is why, as another major part of this proposal, we are putting 130 new GP practices in under-doctored areas, which I presume the Conservative party also opposes.  [Interruption.] Well, I am sorry, but it signed up to a petition saying that GPs should be allowed to set up where they want to set up, and if we want them to work in poorer areas, they should get more money. Not even the Brazilian Health Minister, who was talking to me the other week and who is introducing health centres in the favelas in Rio de Janeiro, was saying that the GPs who work there should get more money, but that is what the Conservatives are saying for towns such as Barnsley and Hull.

Norman Lamb: That might be a concern, but my argument is that these new mechanisms for delivering care should be piloted. They should be tried in various parts of the country so that we can learn the lessons, both positive and negative, and see what the implications are for district general hospitals and community hospitals. We ought to be developing a lot of these services in local community hospitals, which often serve very rural areas. For many communities, that would be a much better way forward than the Government's proposals.
	The Secretary of State, who has left the Chamber remarkably quickly, claimed that this was not a central imposition, but it is. The operating framework for the NHS for 2008-09 states that
	"all PCTs will complete procurements...for new GP-led health centres"
	within this year. What a stitch-up—a centrally imposed direction from Whitehall that must be carried out within such a short time.
	One would have hoped that the Department and Ministers might have learned lessons from the debacle that was the Medical Training Application Service and from the whole business of modernising medical careers. We saw the consequences of imposing an entirely new system across the whole country, without proper piloting, and it ended in disaster, causing many problems for junior doctors. Did the Government learn their lesson from that gross error? No, they did not.
	Here we are again, imposing a system from the centre despite all the evidence, which I shall come on to, from the King's Fund and many others, which ought to be enough to make the Government stop and think, and learn lessons before proceeding further. In future years, this case will provide us with yet another perfect case study of how rushed central imposition fails, with the waste of resources that always happens when attempts are made to impose a measure from Whitehall, with the failure to develop policy based on evidence, and, critically, with the alienation of professionals and communities.
	Let me deal with the subject of the alienation of professionals. The Government have decided to pick a fight with the BMA, and with GPs in general. They quickly dismiss the BMA, accusing it of being luddite and resistant to any change, and saying that it always has been like that and always will be. That view results in the Government closing their mind to legitimate concerns from many doctors about the implications of the proposals. It also closes their mind to the risks of undermining what is already very good in our primary care system. Primary care in this country is the envy of much of the rest of the world. We must never be complacent about the need to improve primary care when it fails, but there is a real risk that the proposals will undermine much of what is so good about the system that we have.
	Alienating communities is not the way to empower communities or local commissioners. The primary care trust in Birmingham mentioned by the hon. Member for Birmingham, Selly Oak might well have its own plans about how it wants to develop services in that community. In my county of Norfolk, the primary care trust has not even finished a review of its estate since it was created in the autumn of 2006, yet this change is being forced on it.
	These decisions should surely be made locally, and should be based on what works best in the area. They should be based on what services are being developed to provide the services talked about in the proposal—such as the community hospitals, which are so critical in serving rural areas. They should be based on the quality of primary care. It is variable; surely that points to a need for local solutions, rather than having Whitehall simply impose its proposals. Surely local commissioners should make such decisions. What are the important principles that should apply, and what evidence is there that existing provision is failing? What evidence is there that polyclinics will provide solutions to any of the failures that we identify?
	The principles behind the proposal are important. First, clearly there are real issues to be addressed in connection with the concept of breaking down the divide between primary and secondary care. The case for providing care closer to home is an important principle, as is the quality of care provided to the patient. As for whether there is a need to improve what we already have, as I have said, we must not be complacent. There is a divide between primary and secondary care, and we should consider all ways of reducing that divide, to ensure that there are better working arrangements between consultants in hospitals and GPs working in the community.
	The quality of primary care is generally, but not universally, excellent. The Royal College of General Practitioners is aware of that; it recognises the variability of care across the country, and the fact that in deprived areas there are fewer GPs. There are concerns that some single-GP practices do not provide the quality of care available elsewhere. Some are very good, but others do not offer care of a sufficient quality. There are financial incentives that encourage GPs to work in the leafy suburbs, but not to work—or stay—in the poorest communities. Those financial incentives need to change.
	There are also concerns about the patient experience. The Secretary of State made the point that if a person has to visit a GP, then a pharmacy elsewhere, and then a hospital for a further check-up, perhaps after an operation, they may make many long journeys. That can be extremely onerous for the elderly and people who live in rural areas. At the beginning of the week, I spoke to a constituent who described making a 60-mile round trip to the acute hospital in Norwich for what turned out to be a two-minute check-up appointment following an operation. None of us can be happy with that situation, so we must have open minds and be willing to consider ways of improving the patient experience.
	It is worth while considering new models of care, looking at what works in other countries, and trying to learn the lessons. Last summer, I visited the Arches health centre in a poor, inner-city part of Belfast. It is, in essence, a polyclinic. It brings together health and social care, and there is a citizens advice bureau in there, too. To all intents and purposes, it looked like an incredibly impressive facility, so I am certainly not dismissive of the concept's potential to work in certain defined conditions, but when the King's Fund looked at the evidence, it raised serious concerns.
	The King's Fund first looked at other countries. There is some bizarre cross-dressing going on; it talked about the original concept coming from the Soviet Union and being developed in many eastern European countries that were part of the Soviet bloc, yet those countries are now moving away from that model, and towards a much more open primary care market. Meanwhile the United States, Germany and Canada are very much moving in the direction of the polyclinic model. As two groups of countries are moving in diametrically opposite directions, the changing enthusiasm for polyclinics surely ought to make us wary.
	The King's Fund also warns that what might look very attractive and work effectively in the States or Germany cannot be translated to this country. It makes the point that there are far more doctors per 1,000 people in Germany, for example, than in this country. So caution is required about simply adopting something that looks good elsewhere.
	The King's Fund clearly recognised the potential for such new concepts of delivering care, but it found no systematic evaluations of polyclinic models in other countries. The Government, however, appear determined to proceed without that evidential base. The King's Fund had real concerns about what it saw overseas. It saw that in many cases, the fact that professionals were working together under one roof did not automatically lead to integrated care; it saw a lack of integration between polyclinics and hospitals. It raised concerns about a lack of continuity of care, whereby the patient did not see the same doctor every time. That is one of the issues that cause elderly people a lot of concern.
	The King's Fund found concerns about a decline in professional motivation and development, where consultants who might previously have been based in hospital centres of excellence end up in more remote settings away from professional colleagues.
	Bizarrely, given the Government's claims, the King's Fund identified a lack of patient choice. Given some of the concerns that have been raised by the BMA and others about the ultimate position with small GP practices closing, the result could be that people in a local area end up with less choice about their primary care centre. They might have no choice but to go to the local polyclinic. That looks very likely to be the case in London.
	The King's Fund also looked specifically at the local improvement finance trust schemes already operating in this country. It specifically examined 12 LIFT schemes that it considered bore all the hallmarks of the polyclinic model that the Government seek to pursue. It said:
	"If anything were to demonstrate the benefits of the polyclinic model in England, it should in theory be evident in LIFT schemes."
	What did the King's Fund find? Its conclusions should worry the Government. It found little evidence of innovation in this country's existing polyclinic model. It found that local authority social services, which were supposed to be integral to those centres, had "fallen by the wayside" and were not continuing to participate in them because of tight local funding streams.
	Crucially, the King's Fund found a lack of clarity about responsibility for strategic development—no one in charge, determining the strategic development of those centres. It found a lack of clarity about who was responsible for overall clinical governance in those facilities. Surely that should disturb the Government. It found that payment by results—the Government's mechanism for funding care, which is a blunt instrument—is causing acute hospitals to have their funding streams undermined where such centres exist, because the polyclinics do the more routine procedures, thus leaving the acute hospitals to do the more expensive procedures, while receiving the same tariff. They are losing income for the simple procedures and receiving too low a tariff for the more complex procedures. All that is swept aside in the Government's determination to rush headlong down this route.
	The King's Fund also found that none of the 12 existing schemes demonstrated savings or improvements in costs compared with previous models of care. They had struggled to persuade GPs to relocate, and had been developed because of a political imperative to introduce them, rather than being based on patient need. The report raised the specific fear that polyclinics would, in effect, become white elephants. It also noted the concern about access. It drew specific attention to the fact that if people have to travel further and for a longer time to their primary care centre—particularly in the more deprived communities, where people might not have access to cars—they are less likely to use that facility. Surely, again, that should be a concern in London, given the proposals that the Government are intent on pursuing.
	When the King's Fund examined the 12 existing cases, it identified a failure to shift any care from remote acute hospitals to polyclinic settings. It is essential to secure local leadership and a shared ambition, which is usually lacking when a model is imposed on an area by Whitehall.
	The King's Fund has stated that, critically, the Government have not answered the question about who will lead on either strategic direction or clinical governance. Until the Government clearly indicate their intentions on centrally imposed GP-led health centres, there will be massive concern that the fears identified by the King's Fund in the existing centres will be realised right across the country, because we have not learned the lessons from the pilots. Foreign evidence also points to the central importance of leadership in such centres. The existing LIFT schemes and the foreign experience should be enough to persuade the Government to pause for thought.
	My plea to the Government is to develop pilots with proper investment. The King's Fund has stated that the focus is often on simply creating the building within which services are provided, without investing in change management, which involves changing services and the way in which patients are treated. We should develop those models, extend the evidence base, sort out the question of leadership and explore the range of models, which include hub and spoke, and locating all GPs in the same building.

Frank Dobson: I am in no position to comment on the appropriateness or otherwise of polyclinics—or whatever the Government's term is in relation to other parts of the country. Polyclinics may turn out to be useful, successful and helpful, but I am here to speak up on behalf of patients and professionals in my constituency who are expressing a great deal of concern about our primary care trust's proposals. Most people in the locality approach the issue with great distrust, because they feel that our area has been used as a testing ground and my constituents as guinea pigs in new approaches to general practice and primary care.
	Until now, our area has been well served with effective and very popular GP services, but it is being subjected to changes that, from the point of view of local people, are unasked for and untried. Recently, three GP practices were privatised—there is no other way to describe it. Three popular practices were required to bid to continue their existence. They met all the quality requirements, and in the assessment they did better than the private sector bidder on all of them, but the private sector bidder put in a lower bid in terms of costs. The bid was never quite clear, because when people inquired into how the situation had come about, they were told that the matter was commercial and in confidence.
	UnitedHealthcare, a subsidiary of an American outfit, secured the contract. I expected—perhaps rather cynically—that it would put on an absolutely wondrous show in the three practices that it had taken over, so that they would serve as loss leaders and as an example of what a good job it could do. My cynicism was not justified, because although a man called Neil Bentley from the CBI has declared them to be a success, he obviously lives in an evidence-free zone. Since the new company took over, appointment times for each patient have been reduced from 15 minutes to 10. If the visit or appointment is unscheduled, people get only 5 minutes and are told that they can talk about only one problem, even if they have more. The new company has not complied with the extra opening hours that the contract specified, and which it undertook to deliver. It closed a baby clinic and then had to reopen it in response to a public outcry. There are rumours—although they are denied—that the company is in the process of going back to the primary care trust to ask for more money.
	That is what has been happening in my constituency, and now we have proposals for polyclinics. These, we are told, will provide community-based diagnostics. There are apparently three proposals for polyclinics in my constituency, and as part of the move to community-based diagnostics, one will be at University College London hospital and another will be at the Royal Free hospital, so we will actually have hospital-based diagnostics and—this will be a novelty—hospital-based community and GP services. Originally, polyclinics were to be targeted at under-doctored areas and populations, which might be worth while if it were the only way to secure the extra doctors and better services required to meet people's needs. But those needs vary from place to place, depending on the geography and on the nature of the population. I have always believed in horses for courses, but I do not think that the Government do. In London, it is certainly not horses for courses but "Thou shalt have a polyclinic." I also believe that it would be a good idea for these things to be tried out in pilot schemes in various parts of the country.
	I must remind Ministers that generally speaking, GP services are very cost-effective, particularly in their role as gatekeeper for the rest of the national health service. I am sure that the Minister would have to confirm that when he talks to Health Ministers from abroad they are envious of the impact of GP services on keeping down costs. It looks, from such evidence as is available, as though where polyclinics, or something like them, exist, more investigations and tests are prescribed, often wastefully, as in the United States—perhaps less so in Germany—and more people are referred to hospital as in-patients. Both those developments may be a good thing from the point of view of patients, but they may also be on the excessive side.
	I have some questions, to which I have not managed to get answers, about the proposed polyclinic at University College hospital. It appears that that scheme will involve everybody who goes there for GP services, as well as everybody who goes to accident and emergency and can walk into the place, as opposed to arriving by ambulance. In effect, far from there being a shift to community services, we are moving towards provision being increasingly concentrated in the hospital. Will the doctors there be able to refer people to other hospitals instead of University College hospital, where the polyclinic will be located?
	Then there is the question of the impact on the area's existing GP services, which are convenient and familiar—two things that appeal particularly to older people, disabled people and families with children. It is also the case that nearly everyone looks for some continuity of care by seeing the same doctor, if at all possible.
	Ministers have said that no one will be forced to join a polyclinic, but when the companies' contracts come up for renewal, will they get them renewed, will the same terms be available to them, and, more importantly, will they be entitled to apply to some of the practices outside the polyclinic? That is not clear at the moment.
	That brings me to the question of who will own the polyclinic. Will it be a private sector outfit? Will UnitedHealthcare, which has already taken over the three GP practices in the area, be able to bid for and take over the polyclinic? If so, that will be despite the fact that its owners have been indicted for fraud and every form of swindling of taxpayers, patients and doctors in the United States. If it gets the polyclinic contract, will it also get the out-of-hours contract, for which it is believed to be bidding? If so, we would end up with a US company having something approaching a local monopoly in part of my area. I remind Ministers that the first priority and statutory duty of the people running a private sector company is to put the interests and needs of shareholders first. It is not just me who says that. Mr. David Worskett, director of the self-styled NHS Partners Network, which is in the private sector, has said:
	"The independent sector has to protect shareholders' interests".
	This company, as an American company, believes in turning diseases into a commodity; that is how it has made its money over the years.
	Camden primary care trust is already putting a massive effort into promoting polyclinics at University College hospital and the Royal Free hospital, but it is not putting the same effort into two practices in Kentish Town that have put themselves forward as a possible polyclinic. They have not had the same level of involvement from officialdom, yet they have a fine track record. They have been providing primary care. They have arranged for consultants to come out and see their patients in their practices. They have run drug and alcohol clinics. They have helped people suffering from drug and alcohol problems to find employment. They have provided psychological medicine. They have provided help for children and families. Social workers have operated from their premises, and so have people from the voluntary sector. These people have a proven commitment and competence, and to develop what they are doing would be the sort of organic development to which the Government should be committed—going with the grain, from the point of view of patients and professionals.
	The London polyclinic proposals are not like that. The Secretary of State and the London health lot say that the proposals are led by the NHS in London, not the Government. I do not understand that. Professor Ara Darzi, who is a most distinguished surgeon and a highly intelligent and charming man, put forward the polyclinic proposals for London. He is a Minister in this Government. Mr. Paul Corrigan, who used to work at Downing street, is the London director of strategy and commissioning in London, and the benighted Lord Warner is chair of the provider agency in London, following his departure from office as a Minister just before all the trouble arose over the problems of junior doctors. Let us assume for a minute that there is no Government influence in the matter. That means that the strategic health authority, which is not accountable to anyone, and the primary care trust, which is not accountable to anyone, are taking decisions. In the end, however, Ministers are responsible, and I believe that they ought to take a step back.
	The next thing I have to say is something conservative: remember the cost of change. The process of change is immensely costly, in terms of money and the amount of time and effort that people have to put into the process of change. I believe that Ministers—

Robert Goodwill: My constituents in Scarborough are perplexed, confused and angered by the proposals. If the Minister comes to Scarborough, as I hope he will very soon, to talk to people there, he will hear that they want more money to be spent on a number of areas in the health service, such as dentistry.
	Scarborough hit the headlines two or three years ago when we had queues going round the block, reminiscent of the Soviet Union bread queues, when it was rumoured that an NHS dentistry practice was opening up. People are very concerned about out-of-hours service, and four years ago the local primary care trust upset the applecart when, by putting the out-of-hours service out to tender, local GPs who were covering those services and providing cover at the local community hospital found that they did not get the contract for such services in the countryside, which meant that they could not also cover the hospital. A lot of money was wasted in one case, when dentists from Germany were brought, at £700 a night for 10 nights at a time, to provide cover.
	Whitby hospital in the north of my constituency is being subjected to death by a thousand cuts, according to many in that area. Services have been reduced. The accident and emergency service is under siege because of the list of incidents that ambulance drivers are told they must not take to Whitby—only the most minor of injuries and illnesses are dealt with there. Maternity is currently under review at Whitby because we are told that there is no demand for maternity services. That could be something to do with the fact that maternity is open only from 9 until 5. The health service is under siege in my constituency, and the Government are coming up with a solution to a problem that many people do not see.
	I would like to share with the House a letter that I recently received from one of my constituents, Mary Thompson. She writes:
	"The last time I wrote to an M.P., it was to complain to Lawrie Quinn"—
	my predecessor—
	"about the lack of N.H.S. dentists in Scarborough. The situation has got worse since then, but I must keep trying.
	This time, it is still the N.H.S., but I would like to tell you about some of my husband Eric's experiences since being diagnosed with bowel cancer four years ago.
	After two major operations, chemotherapy and radiotherapy, the cancer returned and Eric was referred to the Leeds General Infirmary by Scarborough Hospital, who were unable to do any more for him. We saw a Mr. Sagar who arranged for several tests, including a PET scan in London"—
	250 miles away—
	"for which we had to arrange and pay for transport ourselves—no mean feat for someone who had great difficulty sitting comfortably due to the nature of his illness. Eric's operation was arranged for August 18th, the long delay"
	of five months
	"in part due to the fact that a urology team had to be on stand-by as well as the bowel team, and a high dependency bed was also needed as it was not certain that he would even stand the surgery, so big an operation was planned. On the day, Eric was gowned and ready for theatre when Mr. Sagar arrived to see him, extremely angry, to say that the operation would have to be cancelled, because of the two high dependency beds available to him, one had been given to a road accident victim, and the other was needed for the person whose operation was before Eric's—his need was deemed the greatest.
	Apparently there is a shortage of high dependency beds due to government cuts. Eric was allowed to go home for the weekend, but had to return on the Monday to keep his bed."
	That is a 120-mile round trip. The letter continues:
	"The operation now took place the following Thursday, and though successful, was incomplete as he was left with two nephrostomies (tubes leading directly out of his back from his kidneys, emptying into two bags attached to his legs) instead of the urostomy which had been planned. We were never told whether this was due to the postponement of the operation and consequent changes of staff.
	After going home, Eric became very ill on September 21st and our G.P. arranged for an ambulance to take him to the A&E at Scarborough Hospital. We waited two hours, then our son arrived, so we cancelled the ambulance and got Eric to the hospital in his car, where we had the usual long wait in A&E. Eric was unable to stand and found the chairs there very uncomfortable, given his condition. I remarked to a nurse that we had been waiting a long time and she snapped back 'Everyone has to wait—it's part of the system'"—

Graham Stuart: If patients can register with an expensively laid-out new centre, they will take their money away from the GP's surgery—perhaps in the countryside, in an area like the East Riding of Yorkshire—with which they are currently registered. That would undermine the funding of the surgery, and lead to the closure of GP services in areas such as Leven and Beeford in my constituency.

Howard Stoate: There is something funny about this debate. I am the only practising GP left in the House of Commons, and apparently I am the only one with a good word to say about polyclinics. I honestly believe that they will give patients access to services that currently require some to travel many miles, and to which many others simply do not have adequate access.
	In my view, Ministers have given sufficient reassurance that most of the new services will be in addition to the existing ones. GPs will be able to work on a hub and spoke model, retaining their own practices if that is what suits the locality, or to locate their practices in polyclinics, maintaining the integrity of those practices while having access to all the extra services that are currently not so accessible.
	The idea of polyclinics is not new. A recent King's Fund paper on the subject refers to the Dawson report of 1920, which set out a vision of primary health centres that would focus on "curative and preventative medicine" and would provide an opportunity for GPs, nursing professionals, visiting consultants and specialists to work alongside one another. That model is exactly the same as the polyclinic model of today.
	The King's Fund paper suggests that one of the reasons the concept has not made much headway since then is the
	"singular lack of enthusiasm from the medical profession and in particular its BMA representatives".
	The National Health Service Act 1946 allowed health centres along the lines proposed by Dawson to be set up but did not make their adoption mandatory, despite Bevan's enthusiasm for the idea, owing largely to opposition from the professionals. Their opposition stemmed from
	"the BMA's hostility to any proposal which appeared to turn GPs into public servants".
	Unsurprisingly, therefore, by 1963 only 18 purpose-built health centres were in place.
	Vested professional interests were also partly to blame for the failure of the East German polyclinic model to survive reunification. In 2005, an article in the  British Medical Journal by German academics explained:
	"State owned policlinics were one component of primary health care in former East Germany, housing general and specialist doctors and dentists. This integrated model was efficient and cost saving: facilities and laboratories were shared, alternative treatment and prevention strategies were coordinated, and referrals to specialists were well monitored, as well as each patient's case. Policlinics did not conform to the West German concept of independently contracted doctors paid on the basis of an item of service, so they did not survive in East Germany after 1995."
	However, five years later, in 2000, the polyclinic model was back on the agenda in Germany, having been reinstigated by German policy makers in a bid to
	"increase cooperation between general doctors, specialists, and hospitals; to improve communication between institutions; and to reduce healthcare costs."
	That illustrates that we need to be extremely wary about the opposition to the current polyclinics proposals expressed by professional trade unions such as the BMA. The BMA says that it is not opposed to the polyclinics model per se, but that they need to be introduced gradually over time and not be imposed centrally, and that proper regard must be paid to the specific character of each local health economy. That is a perfectly sensible position to adopt, except that the BMA has been saying exactly that from 1920 onwards.
	As long as the polyclinic model remains an aspiration rather than a specific policy objective, the chances are that we will never see them in place across the country. As one speaker said last week at a meeting on polyclinics of the all-party group on pharmacy that I chaired, the irony is that the polyclinic model now being proposed has in fact existed for years in one branch of associated health care at least: veterinary care. In that field, large, one-stop, city centre clinics, comprising both generalists and specialists, and with impressive on-site diagnostic and treatment facilities, have been in place for years and have worked very well. It is pity that the owners of the animals that are benefiting from that kind of one-stop, integrated care are still waiting for something similar to materialise in the NHS.
	Also, other health care systems around the world have, of course, been using the polyclinic model for years. The polyclinic proposal is far from being the untried, untested, experimental model of care that many in the media have claimed. As the NHS Confederation has stated:
	"The principles behind the idea of polyclinics are in line with the way in which healthcare is developing across the world. The design rules that underlie the idea of polyclinics appear to be fairly uncontroversial."
	The case in favour of polyclinics is, in fact, unarguable. They provide an unrivalled opportunity to create larger groupings of primary care professionals, and to create a critical mass that will allow an enhanced range of services to be provided. They exploit economies of scale to provide greatly extended diagnostic support with rapid access and turnaround, and a range of other services that are difficult to offer in smaller practices. They reduce the need for patients to travel to hospital by relocating high volume work that does not require hospital infrastructure. They will integrate services to break down the traditional barrier between primary and secondary care and provide opportunities for specialists to work alongside their colleagues in primary care. They will also create space for other services, including community health services and other related health, social care, leisure, housing and benefits services that patients, professionals and the community will value.
	There are, of course, a range of issues around how, where and why polyclinics are to be implemented, but none of the concerns that have been expressed are insuperable. The idea that they will inevitably undermine the direct relationship between a GP and their patient, for instance, is wide of the mark. The Berlin polyclinic, Polikum, uses a web-based scheduling system to ensure that patients who want to see their own primary care doctor can do so. They may only be able to see their GP during certain periods of the week, but that is no different from how the current system works. As now, patients have to weigh up whether a familiar face is more important to them than speed of access.
	Nor is it necessarily true that patients will have to travel further to see a GP. The hub and spoke model suggested in the Healthcare for London plans offers the potential to preserve local access while at the same time providing a community health care hub that offers a broad range of diagnostic and treatment services. In Liverpool, for example, the local PCT has set up a network of neighbourhood health centres and NHS treatment centres. Under that system, no patient is more than 15 minutes' walking time from GP services while there has been a corresponding shift of services out of hospitals and into the community closer to where people live.
	I suggest that the real issue is not whether the principle behind the polyclinics is the right one—I do not know of any serious commentator who fundamentally disagrees with them—but relates to their implementation, about which legitimate fears have been expressed. For example, the risk is that they could end up duplicating existing services provided in the community, and therefore waste money by creating overcapacity. If, however, their implementation is properly planned and managed and due regard is paid to current services, there is good evidence to suggest that they will help us make more efficient use of existing resources. Well-organised and integrated systems improve cost-effectiveness, reduce follow-up appointments and duplicated tests and improve the quality of care. The Kaiser Permanente model in the US shows us how this can be done, and provided that the polyclinic service contract is properly set and monitored, there is no reason to think that the advent of new providers will impact negatively on the quality of care offered to patients. After all, GPs are, and have always been, independent, for-profit contractors operating within the NHS. Those are the rules GPs elected to play by when the NHS was set up. With proper debate and consultation and due care taken in the commissioning process, there is every reason to think that polyclinics can lead to substantial benefits in terms of the quality of care offered to patients.

Richard Taylor: May I begin by declaring that I am a member of the British Medical Association and a fellow of the Royal College of Physicians? I am not speaking in order to give any official message from either of those organisations, however; I am speaking entirely on my own behalf, and on behalf of my constituents, local GPs and NHS professionals who have spoken to me.
	The debate has produced a huge benefit already, in that we should all now know what we mean by a polyclinic and a GP-led health centre. To me, a polyclinic is a body that brings together GP services, investigative services, probably hospital consultant clinics and probably a headquarters for community services, as well as dental services. That could be perfectly satisfactory in certain areas, particularly in big cities, although I note what the hon. Member for Birmingham, Selly Oak (Lynne Jones) said about her part of Birmingham.
	As for GP-led health centres, the Secretary of State has made it absolutely clear that they need only have three characteristics: they have to be accessible, to be open from 8 am to 8 pm 365 days a year, and to be able to accommodate drop-in patients and registered patients.
	I am grateful to the Minister for his reply to my parliamentary question of 21 May, which he kindly answered in the nick of time just yesterday. I asked
	"whether the decision to have a polyclinic in a primary care trust area is a decision to be made locally."
	If I may, I want to take his answer apart, and agree with certain bits and ask further questions.
	The first sentence of the answer is as follows:
	"How primary care trusts...choose to configure or commission local primary medical care services is a local matter."
	That is absolutely right; it certainly should be. I agree with that.
	The second sentence of the answer is:
	"However, all PCTs have been asked to commission additional general practitioner (GP)-led health centre services and have been given additional funding to secure those services."
	The key word there is "additional". I met the chair and chief executive of my own PCT yesterday, and in their paper about their plans for future health services in Worcestershire they state that the Department of Health requires every PCT to establish a
	"new GP-led Health Centre".
	To my mind, the difference between "new" and "additional" is vital, and I will return to it. I am a little confused about the reference to extra funding; is it really new additional funding, or is it part of the growth money already announced and passed to PCTs?
	The final sentence of the Minister's answer to my question is crucial:
	"PCTs will decide after local consultation where and how these services should be provided and will carry out an open and fair procurement to secure the services they specify."
	Deciding "where and how" is crucial. If extra hours and extra capacity are needed, some of the existing health centres around the country—this is certainly the case in my area—are closed from 6.30 pm and throughout every weekend, so spare capacity exists that could be used.
	In Worcestershire, the GP-led health centre is likely to be in Worcester, the largest town. If only the money for such services were given to the PCTs without strings attached, it might be feasible in Worcestershire to put in place three of these health centres—one in each major town. That would spread the benefit of 8 am to 8 pm opening and the benefit of such centres being open for the entire weekend across the county, but, as it stands, only those who are near enough in the city of Worcester will benefit. Such an arrangement would almost certainly do away with the need for new premises, because that existing spare capacity could be used. That would lessen the worry about continuity of care, and about the lack of local knowledge and of previous knowledge about patients, and it could even mean a rotation between different practices within a given area. Such an arrangement would be ideal. I am asking the Government to get away from insisting that these must be new services, because they could be additional services in areas where there is the capacity to provide it.
	Several hon. and right hon. Members have mentioned worries about the back door into commercialisation, and I share that fear. The last part of the answer to my written question stated:
	"PCTs...will carry out an open and fair procurement to secure the services they specify."—[ Official Report, 16 June 2008; Vol. 477, c. 768W.]
	If it really is open and fair, and if account is taken of the lack of need to build new premises if spare capacity in existing health centres is used, existing practices could probably compete on a fair basis with the huge commercial organisations that are gearing up to compete for the provision of such services.
	The fears of commercialisation have been rehearsed by hon. and right hon. Labour Members, and, in the interests of speed, I shall not go into them. I just want to remind the House about the need for local consultation and for accountability to local people. I went to a lunchtime launch of the Local Government Association health commission's final report on accountability, the executive summary of which said:
	"More recently, there has been a conscious effort to devolve decision-making, giving greater autonomy to NHS providers and setting a smaller number of national standards to sit alongside ones that are locally agreed."
	That is how we should decide on GP-led health centres, where they will be and what they will provide. I am convinced that GPs in their existing practices in the health centres could provide accessible 8 am to 8 pm, 365 days a year, drop-in and registrable services.
	There are alarms about commercialisation, and I wish to request a meeting with the Minister to rehearse with him some of the alarming allegations that I have received about how some of the commercial organisations function and to share with him two crucial letters in the medical press that sound warnings about commercialisation from the United States. I also wish to share the sensible points made by the organisation that is completely divorced from the BMA and is thoroughly rooted in the interests of patients: Keep our NHS public. I humbly request such a meeting.

Mark Simmonds: The motion is all about patients and the provision of health care for the maximum benefit of patient outcomes. This debate has been very revealing, in that the only speakers who supported the Government's policy came from that diminishing dying breed, the ultra-supporters of the Government.
	The debate was opened by the shadow Secretary of State for Health, my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), who gave a timely and devastating critique, mentioning the potential serious problem and the detrimental impact on patient care. He was right to highlight the problems of potential closures, the potential increase in travel distances, and the danger to the fundamental GP-patient relationship. In direct contradiction of what the hon. Member for Cleethorpes (Shona McIsaac) said, he mentioned the dynamic, strong feelings that patients and GPs have on the issue. He also highlighted the funding uncertainties: where will the money to support the policy come from? Even more importantly, he mentioned the fundamental lack of evidence to support the Government's policy, in relation to quality, access and service.
	We then heard the Secretary of State's response. He is usually highly polished and has a Teflon quality to him, but today he was clearly slightly over-excited, rattled and very confused. I suspect that he does not really want to have to defend the policy, because he knows that it does not make sense, particularly in the context of localised decision making—an idea that the Government trumpet—and clearly he was not enjoying himself. He tried to make a difference in definition between polyclinics and GP health centres, but it was clear from other contributions that they are the same. He quoted a London MORI poll in an attempt to support his policy, but the only recent poll that matters in London is the mayoral election, which was clearly won by Boris Johnson.
	The Secretary of State took an extraordinary, uncharacteristic and slightly sarcastic sideswipe at the hon. Member for Birmingham, Selly Oak (Lynne Jones), who made an extremely thoughtful and balanced contribution. Like us and, I suspect, the Liberal Democrats, she is trying to argue for more devolved decision making on how the money is spent. The Secretary of State's response to her contribution was extraordinary. Tellingly, he confirmed that primary care trusts would not be allowed to convert and expand existing practices, even if that was in patients' interests; there had to be a new polyclinic or GP-led health centre in every primary care trust, and even more in London. He made a bizarre attack on Conservative party policy, which is to try to find ways of improving primary care in socio-economically deprived areas, so that we can reduce health inequalities and improve things for those who do not have sufficient access.
	A significant contribution was made by the hon. Member for North Norfolk (Norman Lamb), who rightly confirmed the necessity of local decision making. He made a critical point about the importance of continuity of care, and about the danger that GPs' understanding of individual patients' medical histories could be eroded by the policy direction being taken. We next heard from the right hon. Member for Holborn and St. Pancras (Frank Dobson) who, let us not forget, is an ex-Secretary of State for Health. The current Secretary of State's view is that there is uniformity of opinion in London that polyclinics are a good idea, but that view was clearly shot to pieces by the right hon. Gentleman's contribution. The right hon. Gentleman was right to highlight the fact that the drivers of the polyclinics policy are Ministers in the Department of Health. The policy is not a response to patients' needs, to the NHS in London or to primary care trusts' desires elsewhere in the country.
	My hon. Friend the Member for Scarborough and Whitby (Mr. Goodwill) made a significant contribution. He was right to challenge the idea that the proposals would be the best use of resources in his constituency. In a lucid, considered contribution, my hon. Friend the Member for Basingstoke (Mrs. Miller) highlighted concerns in her constituency. At the time of his speech, the hon. Member for Dartford (Dr. Stoate) was the only Member to have supported the Government line. He is clearly very knowledgeable about the health service as a result of his professional qualification and his career, so it is sad that he always rises to defend Government policy, irrespective of what it is. He does not, perhaps, use his expertise and knowledge to make constructive suggestions for the Government. The hon. Member for Wyre Forest (Dr. Taylor) made a telling contribution, as always. He made one particularly good point: the policy should not be about buildings, but about patient services and pathways. That is one of the fundamental errors in the direction of Government policy.
	I will not allow Conservative Members to be painted into a corner and seen as the representatives of the British Medical Association. We are not its representatives; we are here to fight for patients and the improvement of patient services. We are not against polyclinics or GP-led health centres per se. In fact, when they are supported by patients, GPs and the local community, we will be supportive and will facilitate them and enable them to be introduced. However, the decision should be taken locally, and should be based on clinical evidence, and evidence on health inequalities and prevention measures. There should also be a comprehensive understanding of the impact on existing provision.
	The House needs to understand that we are not talking about a minor tweak to primary care. The establishment of polyclinics and GP-led health centres will be the largest change to primary care since the establishment of the NHS. In many places, including the Secretary of State's constituency, it has been said that the change would act as a catalyst for the reconfiguration of local GP services. It should be for local primary care trusts and patients, not Ministers in the Department of Health, to make the decision.
	Of course the Secretary of State is right that there are circumstances in which health centres of polyclinics would have a beneficial impact. He rightly gave the example of preventing multiple appointments and additional travel, particularly for the elderly and the vulnerable. We also recognise that there should be greater access to diagnostics and follow-up appointments, and it may be that such centres are the appropriate place to provide those services, but not everywhere, not uniformly, and particularly not in rural areas.
	Very specific criteria were set down by Darzi that the polyclinics and GP-led centres would be both cheaper and more accessible, but some hon. Members' contributions have demonstrated that that is not the case. The Government need to answer some specific questions. They do not seem to understand that there is a direct correlation between GPs and patient care and a threat to that relationship. Will the Minister also explain in winding up the debate whether a GP-led health centre means a GP presence all the time, from 8 to 8, seven days a week, 365 days a year? Why are there no pilots to produce evidence that the Department of Health can analyse?
	The Secretary of State confirmed for the first time that, on average, there will be five GPs per centre outside London. That amounts to an additional 605 GPs. Where will those additional GPs come from, in the context that there were only six more last year, if they do not come from surgeries that are already in place? Why will Ministers not allow PCTs to invest instead, where appropriate, in community hospitals or other GP-led health centres—a point made by my hon. Friends the Members for Beverley and Holderness (Mr. Stuart) and for Scarborough and Whitby? Why will Ministers not allow additional facilities to operate in non-spearhead PCTs—for example, outreach services?
	The policy is confusing. Lord Darzi said in his framework document that PCTs would not be allowed to reconfigure services until a PCT clinic review has taken place, giving evidence of the benefits. Where is the evidence—I hope that the Minister will explain this—to support the supposed benefits of a centrally prescriptive solution that is odds with locally determined reconfiguration? I suspect that the answer to those questions is that a one-size-fits-all proposal is not really about patient outcomes, but about political outcomes.
	There is an inherent contradiction between devolving commissioning responsibilities to a PCT through practice-based commissioning, and proposing a centralised approach to service design, with plans for polyclinics or GP-led health centres in every PCT. The Opposition will not coerce doctors into polyclinics against their will. GP-led health centres should be able to offer additional services, such as physiotherapy and phlebotomy, but they can be provided in other facilities as well in the existing system. This is not just about new buildings. Under the next Conservative Government, primary care will be patient-centric, responsive to local communities and free to innovate, ultimately to drive better patient outcomes.

Ben Bradshaw: Our primary care system of family doctors has served this country very well and is the envy of the world, and the Government are investing record sums in it. Funding for GP services has increased from £3 billion in 1997-98 to £7.86 billion in 2006-07. There are 19 per cent. more GPs today than in 1997. Incidentally, there were 273 more, rather than the six more mentioned by the Conservative party, in 2006-07 alone. They are better rewarded than ever before. More doctors are in training to become GPs, and vacancy levels for jobs are the lowest for many years.
	The new contract has also brought important benefits for patients: being able to see a GP within 48 hours or to book ahead, longer consultations and better outcomes. But in every recent survey of what the public would like improved in the health service, being able to see a GP at times that are more convenient for them comes top. That is part of the reason why in March we agreed with the BMA that surgeries offering opening in the evenings and weekends will be rewarded. I am pleased to tell the House that today 21 PCTs already have achieved the aim of at least 50 per cent. of GP surgeries opening in their areas either on a weekday evening or at weekends. We are confident that the rest of England will do so by the end of the year.
	Even with more than half of GPs offering extended hours, there may still be some people whose GP, for whatever reason, does not wish to open in the evening or at weekends, and we think it only fair that those people, too, should have the possibility of getting to see a GP at more convenient times. That is why we announced last autumn an extra £250 million to enable the local NHS to establish a new GP-led health centre in every PCT in England and extra GP surgeries in the least well-served areas. That is additional money on top of, not instead of, the record sums already going into existing GP surgeries. No one will lose their current family doctor as a result.
	In fact, one of the specific features of the new health centres is that people will be able to remain registered with their own doctors and see GPs in the new centres if they wish. The centres will be particularly welcome for people who work full time or commute, who currently find it hard to visit a GP, and they will also take pressure off accident and emergency departments, which deal with a lot of people who should see a GP. The only requirement we are placing on the centres is that they should be open seven days a week, 12 hours a day, and offer appointments and walk-in services.
	The hon. Member for North Norfolk (Norman Lamb) criticised the Government for moving too fast and predicted that we would live to regret our extra investment in primary care services. I suspect that when his constituents begin to enjoy the extended opening hours of GPs in Norfolk and the new 12/7 GP health centre in Norwich, or wherever Norfolk PCT decides to locate it, he will regret his opposition to those improved new services. He quoted the King's Fund report, which was much more balanced than the impression he gave—but of course, it was an analysis of a policy that is not being proposed.
	The hon. Member for Scarborough and Whitby (Mr. Goodwill), like a number of Conservative Members, said he was opposed to the new investment in his constituency. I am sure that other parts of North Yorkshire, such as York and Selby, might welcome it. His local PCT, as he well knows, will have assessed the needs of Scarborough and Whitby, and I understand that a public meeting in his constituency this week supported the proposals. He also said he was concerned about the provision of dental services. He might like to suggest that the PCT considers including extra dental services in the new centre. That is exactly what many PCTs up and down the country are doing. He asked whether the services need to be provided under one roof. No, they need not.
	The hon. Member for Basingstoke (Mrs. Miller) also said that she opposed the extra investment, in spite of the very significant population growth in her area. I suggest to her that, as in North Yorkshire, there are plenty of people in Hampshire who would welcome that extra investment. It is also not the case, as she suggested, that the existing GPs whom she mentioned cannot bid to run the new health centre.
	My hon. Friend the Member for Birmingham, Selly Oak (Lynne Jones) is due to get not only a new health centre but a new GP surgery in her constituency because it is one of the under-doctored areas. Her constituents do not enjoy the same access as people in neighbouring constituencies in the heart of Birmingham, which has reached 75 per cent. access for extended hours on behalf of its patients. There is nothing whatsoever to stop the GP practice that she mentioned bidding for the new health centre. It need not be a new building; it can be an expanded existing building, and we have repeatedly made that clear.
	I make the same assurance to the hon. Member for Wyre Forest (Dr. Taylor). The new services can be part of an existing system, and there is nothing to stop Worcestershire adopting the kind of model that he favours. If he wants to make that case to Worcestershire PCT, he is very welcome to do so. The current proposal is for Worcester, but if he wants to persuade the PCT that his model is better, I wish him good luck. Of course, I would be very happy to meet him, as I always am.
	My hon. Friend the Member for Dartford (Dr. Stoate) made a very strong case in support of the improvements that we are making to primary care, as did my hon. Friend the Member for Wigan (Mr. Turner). He well knows that he will get not only a new health centre but three new GP practices in one of the most under-doctored areas of the country. He also made an important point about the huge public health benefit of investment in primary care.
	My hon. Friend the Member for Cannock Chase (Dr. Wright) gave an example of some of the disgraceful and irresponsible scaremongering by the BMA and the Conservatives that has caused unnecessary anxiety to patients, including his constituents. My hon. Friend the Member for Cleethorpes (Shona McIsaac) also welcomed the new investment and improvement in services.
	My right hon. Friend the Member for Holborn and St. Pancras (Frank Dobson) referred to a procurement that has nothing to do with the extra investment that we are announcing but is an ongoing process of PCTs procuring new GP services. His local PCT says that it is perfectly happy to defend the way the procurement was carried out. If it is not happy with the provider's performance, it can terminate or not renew the contract. I understand that the proposal for a new health centre in his area involves housing it in a local hospital because that is an accessible point locally, unlike in some other parts of the country where hospitals are not necessarily as accessible as other places.
	It is not only patients who welcome the new services. Anna Waite, a Conservative councillor in Southend, told her local paper two weeks ago that
	"this is a big step forward. A large surgery with easy access and in the right location will be ideal. To be open seven days is fantastic."
	Labour Members are delighted to have been given another opportunity to defend the Government's record on the NHS and highlight the further improvements under way in primary care. We do not think it unreasonable, given the record sums going to GP practices, that people should be able to see a GP in the evening and at weekends. We will not reverse those improvements or give a veto over health policy to the doctors' trade union, the BMA. I recall a similar campaign by the Conservatives this time last year against what they claimed was a programme of hospital closures. That campaign was humiliatingly abandoned when they were forced to admit that they had got their facts wrong. I predict a similarly bruising fall from this bandwagon.

Nick Herbert: I beg to move,
	That this House is concerned that a failure to plan adequate prison capacity has led to the End of Custody Licence scheme and the early release of 26,000 prisoners; notes that the current rate of prisoner release is running ahead of initial projections so that an additional 5,000 prisoners will be released early in a full year; expresses grave concern that no decision on whether to suspend this scheme will be taken until 2009, at the earliest, when prison capacity reaches 86,000 due to the Government's delayed prison building programme; agrees with the Lord Chief Justice that early release schemes erode the sentences originally handed down; further notes the low levels of public confidence in community sentences; recognises the objections of local communities that prisoners released early on home detention curfew are being housed in over 150 residential areas, without consultation, under the Bail Accommodation and Support Service scheme managed by ClearSprings; further notes criticism of the Youth Justice Board for failing to meet targets on youth crime; further expresses concern over plans to link resources to sentencing through the creation of a Sentencing Commission; and calls upon the Government to introduce honesty in sentencing, cancel the End of Custody Licence scheme, suspend the Bail Accommodation and Support Service policy and take immediate steps to ensure adequate prison capacity in the interests of public safety.
	This is the third debate that we have called in the House within a year on the early release of offenders. Since we debated the matter in July 2007, the situation has deteriorated. Last July, the prison population was more than 80,000; now, it is more than 83,000—an increase of almost 3,000, even after factoring in the early release scheme that started in June 2007. Last July, the Government had released 3,800 prisoners early; now, they have released 26,300 prisoners early. The prison estate is running at 99.8 per cent. of total capacity. In July, 86 prisons were overcrowded; now, 89 are. In July, 60,337 prisoners were in overcrowded jails; at the end of May this year, there were 63,176—another increase of 3,000. Almost one year has gone by, and that is what the Government have achieved.
	Sentencing policy and the continuing early release of offenders is a cause of real public concern, yet we return to the issue this evening because the Government simply are not listening. That is why the debate has had to be called. We have repeatedly asked Ministers to explain how they are going to provide the necessary prison capacity to hold all those sentenced by the courts, but instead of action, we have been presented with a litany of poor excuses. Ministers say that they have provided 20,000 new prison places, and I am sure that we will hear it said again this evening. They do not say that almost 17,000 prisoners are now doubling up in cells—twice as many as when Labour came to power; that those extra places have been provided by doing such doubling up; and that almost one quarter of the entire prison population are housed in cells that are designed for one fewer person.
	Ministers say that they are embarking on a record prison-building programme, but the truth about their record is that after years of opposition from the former Chancellor, now the Prime Minister, they started the programme too late and it is already falling behind. Ministers say that they are tackling reoffending, but reconviction rates have increased. Even after the counting change, which Ministers are now so quick to fall back on, reoffending rates by ex-prisoners have risen since the Government came to power.

David Davies: My hon. Friend is making some powerful and important points. Could he confirm that if he becomes Minister for Justice, as I hope he will shortly, he will end all forms of automatic early release and prisoners will be released only if they have earned the right to get out of jail?

Nick Herbert: I agree with my hon. Friend. I believe that the Government have pursued the policy of titan prisons—a name that they chose—because they wish to subvert local planning procedures and thereby increase capacity without having to obtain the consent of local people. That is wrong, just as the policy of siting very large prisons away from the prisoners' local communities is wrong.
	The Government's paper trumpets the potential efficiencies of titan jails, but admits that the Ministry of Justice has not done enough research to present a cost-benefit analysis. If these monstrous warehouses ever get built, projections show that they will be overcrowded by almost a third from day one. Old habits certainly die hard. In the short term, prison capacity pressures were going to be addressed by the acquisition of a prison ship. Whatever happened to that? What happened to that ghost ship? Perhaps the Secretary of State could update us.  The Sun is certainly keen for an update.
	Years of failure, and today's belated and inadequate prison-building programme have come at a price. In an interview with  The Daily Telegraph in May, the former Lord Chief Justice, Lord Woolf, clearly warned of the dangers when he said
	"The present situation is extremely worrying. I don't think prisons will blow up tomorrow or next week but there is certainly a danger of that. The prison service is very good at handling prisoners, but they are at bursting point. We are getting into the danger area."
	Can the Secretary of State tell the House what the current state of the prison-building programme is, how many new places will be opened this year, and why the prison-building programme this year and last year fell so far behind plans?

Jack Straw: The drug treatment and testing orders were reformed into a better and more effective system.  [Interruption.] I am making a serious point about community punishments to the hon. Gentleman, as he knows, because he served on the Committee that considered the 1998 Act. He complained then about the fact that the prison population was too high. It was 60,000. Lord alone knows what he is going to be complaining about tonight when it is 83,000! By definition, community offenders are not locked up and it is more difficult to deal with them. We have to see whether a particular approach works, and if it does not, to be ready to amend it. That is what we sought to do.
	Perhaps I can make a little progress after those diversions. As I said, crime is down by a third. I am glad that we agree about that, not least with the backing and support of the Leader of the Opposition. It includes violent crime coming down, and a record 140,000 police officers. The chances of becoming a victim of crime are the lowest since the British crime survey began its operation in 1981.
	Let us also compare our record with the system that we inherited. On youth crime, it was taking 142 days— 20 weeks—to get a young offender from arrest to sentence. That is now down to 60 days. The hon. Member for Arundel and South Downs criticises our record on prisons. I am very happy to compare our record with the record of the previous Conservative Administration.  [Interruption.] It is no good his saying that he does not want to do that, because it was some time ago. That Administration is the paradigm for the Conservative party today. Conservatives seek to quote its record selectively when it suits them.
	Hon. Members might want to use the noun "crisis" to describe the prison situation, but by God, there was a crisis for many years throughout the 1980s and 1990s! More people escaped from so-called secure prisons in a week in 1992 than escaped in the whole of last year. I am told that it got so bad that private secretaries would not bother to inform Ministers following each escape; they would tot them up at the end of the week.  [Interruption.] It is true.
	Throughout the 1980s and 1990s, prisons were beset by crippling riots. It was a rare month between 1982 and 1995 that police cells were not used, and in considerable numbers. On average in 1992, more than 1,000 prisoners were housed in police cells every night, and that was by no means a record. During one month a few years before that, 3,500 prisoners were in police cells in a single month.
	We had the early custody licence in abundance on a number of occasions, but they were disguised by the previous Administration, most spectacularly when Douglas Hurd, now Lord Hurd of Westwell, extended remission from one third to one half, releasing 3,500 prisoners—not 1,200—at a stroke, the effect of which continued for many years. However, the Conservatives did not volunteer to do what I did, which was to ensure, because I thought it was right to do so, that monthly independent figures were produced on their equivalent of the early custody licence.
	In 1984, Leon Brittan increased eligibility for parole for short-term prisoners. That doubled the number released early. In 1991, Lord Hurd's temporary measures were made permanent in the Criminal Justice Act 1991.

Dari Taylor: Will my right hon. Friend add two more statistics to those that he has given? One is the number of convictions that took place during the late '80s and early '90s. That fell by a third. The second statistic is that crime trebled in the same period.

Jack Straw: The hon. Gentleman knows that to be nonsense, but may I say how pleased I am to see him in the Chamber? Like an awful lot of Members on both sides of the House, when I received the message that a "David Davis" had decided to resign, I thought it was him. It was a great relief to us all—except, I think, the Leader of the Opposition—to discover that he is still here, young and vigorous, and that it is the other "David Davis" who has decided to go off on a frolic of his own.
	Let me now return to the subject of the increase in the number of prison places. We have delivered more than 23,000 additional places since 1997, at twice the rate achieved by our predecessors, along with a commitment to increase the total to 96,000 net and 101,000 gross by 2014. There is some flexibility in the system.
	The hon. Member for Arundel and South Downs asked about the building programme. All the evidence that I have suggests that it is well on time and, in some cases, ahead of time. I am not sure where the hon. Gentleman's information originated. Over the past 12 months 2,422 places have been delivered, and we plan, and fully expect, 2,700 to be delivered in this calendar year. It is also a great credit to the Prison Service that not only is it delivering those places but—here I touch wood—in 11 years there have been no category A escapes.
	We have a responsibility to provide enough prison places for those who the courts determine should be there. Prisons are first and foremost places of punishment and public protection, but they are also places of reform, which means ensuring that there is a constructive regime that gives people on the inside a better chance of going straight on the outside.
	Prisons are not cushy. I was glad to note that the hon. Member for Arundel and South Downs told a recent CBI conference:
	"I do not believe that prisons are holiday camps or that prisoners largely want to be there".
	Perhaps he will talk to his hon. Friend the Member for Monmouth (David T.C. Davies). It is nonsense to suggest that prisoners want to be in prison, nor should they want to be there, because, as I have said, the purpose of their incarceration is first and foremost punishment.
	As for prison regimes, they have been hugely improved since, in particular, the 1980s and early 1990s. Reoffending rates have fallen—I would be happy to write to the hon. Member for Arundel and South Downs about that—and we have provided more opportunities for rehabilitation. My right hon. Friend the Minister of State will tell the House later about the new offender compact that he is developing. There has been a tenfold increase in spending on drug treatment programmes, and the number of people failing mandatory drug tests has fallen by two thirds.

Jack Straw: West Dorset. Of course, how could I forget? The right hon. Gentleman went AWOL during the 2001 election.
	The right hon. and learned Member for Folkestone and Hythe went to enormous lengths to try to introduce a system of honesty in sentencing. He produced one plan, which was in the original Crime (Sentences) Bill in 1996, but he had to withdraw it because it was completely incoherent. He then produced another plan, which I was ready to implement when we came into government in May 1997, but that also turned out to be incoherent and would not have produced honesty in sentencing.
	Of course we should be explicit about the minimum and the maximum that any individual prisoner will serve, but the resource costs of what the hon. Member for Arundel and South Downs implies are huge, at a time when the shadow Chancellor keeps criticising us for spending at current levels and suggests that public spending under a Conservative Administration—were that ever to happen—would be much less. No one will take the hon. Gentleman's proposals seriously unless he can say exactly what the resource costs will be and where that money will come from.
	The hon. Gentleman also has to say who would decide, once a judge has determined that there will be a sentence of between two years and four years, whether two, three or four years are served. Would it be the court? I think the judges would like to have some control over that. Or would it be a prison governor? How would that work? Or would it be done by an additional layer of complicated bureaucracy for the parole board? Those are serious questions and the hon. Gentleman needs to answer them.
	The hon. Gentleman also proposed a sentencing commission. As I said on 5 December last year, and have repeated since, there is no suggestion that a sentencing commission—such as an upgraded Sentencing Guidelines Council—could or should ever be used to fetter judicial discretion or to manage the prison population down. The prison population will rise for the next to 10 to 15 years according to almost any scenario one can foresee, and Parliament and everybody else accepts that.
	I listened carefully to what the hon. Gentleman said. Parliament does have a critical role to play in setting the framework for sentencing, and in deciding on the level of taxpayers' money to be spent on prison places and probation services that arise from that framework. That is nothing to do with linking individual sentences to the availability of resources. We make different judgments to those in the United States, which typically spends four or five times as much on prison places and has four or five times as many. We spend more per head than other jurisdictions in Europe, apart from Portugal. There is an argument for spending some more, and we are doing that, but we do not want to see either the low level of sentencing that some European countries have or the very high level that some states in the US go in for.
	We seek a formal mechanism whereby the impact of proposed sentencing changes is assessed by an independent body, which we would call a sentencing commission, so that Government and Parliament are properly informed about the decisions that they take and understand what resources will be necessary to deliver those changes. We do not seek a restriction on judicial independence, but rather much better information about the resource implications and consistency of sentencing. The fact that offenders in Surrey found guilty of an indictable offence in a magistrates court on an either-way offence have a 9 per cent. chance of being sent to prison, whereas in Bedfordshire it is a 23 per cent. chance, raises questions about consistency of sentencing and which approach is better. I am not saying that we should ever tell sentencers what to do, but we need to have the debate and for sentencers to be aware of it.
	There are already guidelines laid down by the SGC, which is chaired by the Lord Chief Justice, and that works well, but I want to build on that, not least to ensure—as many of the judiciary are aware—that there is much better information available to the judiciary. Rather than damning the report by Lord Justice Gage and his distinguished colleagues before even seeing it, the hon. Gentleman should await its publication. He was, if I might say so, tilting at windmills earlier. I do not want this—

Dan Norris: Is that the reason why Liberal Democrat policy is not to imprison drug offenders?

David Howarth: I have heard the hon. Gentleman make that point in the past, but that figure is produced by the fact the people in that category commit very different crimes from the people in the categories that are given shorter sentences. However, he is right in one respect: we should be looking at what works to reduce reoffending. That is the crucial question. If prison worked in the way that he thinks it does, I would be prepared to think about it as a way forward; but, unfortunately, in general, it does not. Short sentences especially do not work.
	We know about a number of different ways to sentence offenders that work better. The most of obvious one is restorative justice, whereby the offender is confronted with the victim and with the harm that has been done to the victim. Reconviction rates in restorative justice have been consistently found in scientifically controlled experiments to be much lower than when offenders are given other sentences. The difference varies between 15 and 26 percentage points lower—a vast improvement. It works even better for some more serious crimes than for less serious crimes. It also helps victims with the trauma and pain of being victims and helps them to overcome their experience. One of the big questions that those of us who have been victims of crime always ask is, "Why me?" Restorative justice helps to deal with that feeling. Will the Lord Chancellor state when we are likely to see the evaluation of the London trials of restorative justice, which he promised would be published this month?

David Howarth: That is certainly the case, and I will move on to discuss what does not work. Other approaches may work, such as community justice panels, which have been tried in south Somerset—there is some evidence that that approach is successful.
	We know that certain things will not work. Titan prisons have been mentioned, but the evidence suggests that they are unlikely to be successful. What do we know about unsuccessful interventions? Short, sharp shocks did not work; boot camps did not work; and there is increasing evidence that antisocial behaviour orders and tagging do not work. What do all those things have in common? They are all tough-sounding, popular and populist, but, most importantly, they do not work.
	The same is true to a large extent, although not to a complete extent, of prison. Prison is by far the most popular sentence with the public, the media and the hon. Member for Monmouth (David T.C. Davies), but it does not work, at least not in the way in which it is implemented in Britain. That takes us back to the question why our prisons are so ineffective compared with, for example, prisons in Denmark. The Government amendment boasts about the Government's prison-building programme, which is bizarre in a country where prison is so unsuccessful. That approach might make sense in another country where prison is more successful, but not here. So, the central point is that over the years, vast resources have been poured into policies that we all know do not work. It presumably happened because those policies, as my hon. Friend mentioned, are more popular than the policies that we know will work. So, what do we do? It is not enough to say that sentences must be tough if toughness means ineffectiveness. Effectiveness should be the touchstone of policy making, not toughness. But the issue is worse than that. If we put into ineffective policies public money that we could have put into policies that work and reduce crime, in effect we allow more crime than there would have been had we put the money into the right policies.

Humfrey Malins: Oh, if I had time tonight, I would tell the hon. Lady just where the Government have failed. She was not here earlier when we discussed drug treatment and testing orders—the great panacea—which were introduced a few years ago. Does she know anything about them? They collapsed—abandoned; failed—with an 80 per cent. reoffending rate and a 90 per cent. breach rate. Does she know that? She comes out with these platitudes about what the Government are doing here and there, but they need to do a lot more.
	What about the young man from the rotten estate, who has a Prozac-addicted mother and a violent father—alcohol, no self-esteem, no education, no job, nothing—and who has to be sentenced? He has drifted into heroin and we have got to get him out of it. It is no good sending him day after day through the revolving door of prison. That is no good at all. What we have to do is think constructively, which brings me to my last point on sentencing.
	We should think more about residential rehab for drug offenders. I have seen it; I know it can work; I have passed the sentence. There are no statistics showing how successful it is, but my goodness it can often be better than prison because sometimes these heroin addicts are victims just as much as criminals. Something has to be done. Prison costs £800 a week; residential rehab, on average, £675 a week. All around the country, these residential centres cannot get enough money; there is no money around. Yet the judges want to pass that form of sentence more and more.
	There are two further issues. First, on knives, we have got to do something rather than just talk about it and snatch a headline, which we can all do from time to time. Secondly, drugs are, in my judgment, the biggest evil that the criminal justice system has faced during the past 15 years. It is the thing that destroys most lives and ruins otherwise good young people. I repeat that we have got to take a more positive attitude.
	What is my last word? Cannabis. Sentencing on cannabis has been a joke for 25 years. "Smith, you are charged with possession of cannabis, how do you plead?" "Guilty." "Stand up. You are fined £50 and the drug will be forfeited and destroyed. Next case, please." Spare a thought for the next case, which is crossing a red traffic light—the penalty: £100. We do not take it seriously enough, early enough. That is my last comment.

Mark Pritchard: I am conscious of the time, so I shall be brief in order to allow my hon. Friend the Member for Monmouth (David T.C. Davies) to share his important thoughts with us. I congratulate my hon. Friend the Member for Woking (Mr. Malins) on making a speech that was brief, but also wise and thoughtful; he is a man of great experience and integrity.
	The Secretary of State was slightly embarrassed earlier when my hon. Friend the Member for Arundel and South Downs (Nick Herbert) reminded him of the record prison population—and rightly so, because overcrowding is unhealthy, it increases risk and is perhaps itself unlawful. My concern is for prison staff, as I believe overcrowding is increasing the number of assaults on them. It clearly causes great stress within these facilities. Indeed, prison officers are often going off work with stress, which in some cases leads to long periods of sick leave because of the extra pressures in overcrowded prisons. The Government have a duty to look after not only the prisoners but, perhaps even more so, the prison staff within their employ. They are failing to do that.
	I would like to focus on Shrewsbury prison, which is a major prison in Shropshire and the nearest to my own constituency. The prison provides accommodation for 181 prisoners, but the actual population, on the basis of figures released just a few months ago, is 329. That means an overpopulation of 182 per cent. Shrewsbury prison is the most overpopulated prison in England and Wales. That is a disgrace, not only for those seeking education and rehabilitation within the prison so that they do not carry on reoffending, but for the hard-working, committed and dedicated public servants who staff the prison.
	We heard earlier from the right hon. Member for Leeds, West (John Battle), but he neglected to tell the House that Leeds prison is currently 151 per cent. overpopulated. It is wrong that West Mercia police are being called upon time and again to act as full-time custodial officers, taking prisoners not only from Wales but from parts of the west midlands such as Wolverhampton. Once again, that is down to the neglect and failure of the Government. The right hon. Member for Knowsley, North and Sefton, East (Mr. Howarth) said earlier that he did not want to be partisan or party political—absolutely not, but it is interesting that those comments are made only when the Government are desperate for friends; when they do not need friends, they are very happy to be adversarial and partisan. On an issue of such importance, it is right that we bring the Government to account, as we are attempting to do this evening.
	I would like more thought given to the number of foreign nationals in our prisons. Of the 83,000 people now in prison, 11,000 are foreign nationals. We need a review to find out how we can get some of them to serve their sentences in their own countries, perhaps by having some financial arrangement with the home countries. I suspect that it would be less than the £30,000 a year that it costs the British taxpayer to fund prison places for each individual.
	We have heard about rehabilitation. It is absolutely right that we should try to get people off drugs and rehabilitated. I am glad that my right hon. Friend the Member for Witney (Mr. Cameron) is committed to having 20,000 extra drug rehabilitation places. I commend him on that. Education, libraries and access to learning are also crucial. Of course, as we have heard, all those are stagnating because of the current overpopulation of many prisons.
	The third sector—the voluntary or charitable sector—provides many answers to many of the problems discussed tonight. Yet the Government are not freeing up the organisations within it, and not giving them enough access to come into prisons to provide those valuable solutions that we all seek.
	I commend prison chaplains on their excellent work. I hope that political correctness, or pandering to certain minorities, does not mean that the Government put up barriers to their excellent work. I hope that the Minister of State, who is looking slightly confused, will go on the record as saying that he supports the work of prison chaplains, and that he would speak to any prison governor who tried to throw them out because of political correctness.

David Davies: The hon. Lady is trying to do what the Home Office does—blind us with statistics. One of the reasons why there are so many people in prison is the number of foreign nationals who were not here under the Conservative Government. If we look at the number of indigenous British people in prison, we see that the overall number is not much greater.
	This is yet another example of the way in which statistics are twisted and turned in an attempt to hide the fact that this Government are soft on crime and very soft on sentencing. Perhaps that is because they have swallowed too much of the anti-prison propaganda that has been emerging for far too many years from the Howard League for Penal Reform and many similar organisations—which, I might add, are not even prepared to debate the issues in public. Every time I receive an invitation to attend one of their conferences I write back, "Give me five minutes, give me three minutes, give me one minute, and I will stand up on the platform and prove that you lot are absolutely wrong." They never even bother to reply.
	The reason why those organisations are wrong is that they talk about the costs of prison, which is an argument that we heard earlier this evening. Let us examine those costs.

Edward Garnier: No, it was not that good, but it was a thoughtful and constructive speech, I enjoyed listening to it and I hope that the Government will pay attention to it.
	I also found the speech made by the right hon. Member for Knowsley, North and Sefton, East (Mr. Howarth) thoughtful. The interventions that I made upon him were deliberately designed to find out more about the work of Lord Justice Gage's working party. I had not realised that the right hon. Gentleman was a member of it, but, having heard him speak, I am glad that he is. I take him at his word when he says that he is not interested in making party political points during its deliberations, because I am sure that he is not. I look forward with interest to reading the final recommendations of that working party, as I am sure we all do.
	None the less, I retain my concerns about the motives behind the setting up of the working party and about this dangerous collision point between the Executive and the judiciary—I leave aside the concerns that we have as parliamentarians—on the interference with judicial discretion on sentencing. Sentencing is about the most difficult judicial task that sentencers have to carry out, and although the sentencing commission might be set up for one purpose, we need to be extremely careful that it does not achieve another.
	My hon. Friends the Members for The Wrekin (Mark Pritchard) and for Monmouth (David T.C. Davies) were crammed in at the very last moments of this debate and, not for the first time, they made some powerful points very powerfully. Time does not permit me to speak sufficiently about what they had to say.
	It is not an idle boast when I say that the Conservatives are genuinely thinking hard about the issues that face us. The prison population is too high for the available capacity, and we want prisons to do what they cannot do at the moment: we want them to become places of education, hard work, rehabilitation and restoration. That would mean that prisoners who justly go to prison for committing serious crimes come out repaired, not only so that they do less harm to themselves, but so that they do real good to their families and those who live close to them.
	Some £11 billion is wasted in the criminal justice system on reconvicting people, and we want to unlock that money and use it to get people off drugs, to teach people to read and write and to make them employable. It really will not do for the Secretary of State and his Ministers to tell us how much money they have put into the system, if nothing comes of it.
	My hon. Friend the shadow Secretary of State had an exchange with the Secretary of State about the prison service instruction on those unlawfully at large. Again, I am afraid that time does not permit me to go into detail, but that is a live issue that the Secretary of State needs to resolve. The public cannot be expected to have any confidence in the criminal justice system if they get the impression that people who escape from prison and are unlawfully at large are rewarded, when they should not be.
	My 10 minutes is up, and I must not trespass on the Minister's time. I have much more to say, and I hope that the fact that I am bringing my remarks to a conclusion will not give the Government a chance to say that we have nothing to say. We have—it is in our paper "Prisons with a Purpose". I urge the Minister to read it, learn from it and produce policy on the basis of it.

David Hanson: We have had an interesting debate, which began with a fiery speech by the hon. Member for Arundel and South Downs (Nick Herbert), who raised several points that he has made on other occasions. Speeches from Back Benchers ended with a particularly fiery one from the hon. Member for Monmouth (David T.C. Davies). We do have several anger management courses in prison in which he could participate if he so wished. We also heard, as the hon. and learned Member for Harborough (Mr. Garnier) pointed out, some thoughtful speeches, not least from the hon. Member for Cambridge (David Howarth), my right hon. Friend the Member for Knowsley, North and Sefton, East (Mr. Howarth) and the hon. Member for Woking (Mr. Malins). This last raised the serious issues of knife crime and drugs. I hope I will have time to address some of those issues in some depth, if not to the complete satisfaction of Members.
	As my right hon. Friend the Secretary of State said, the Government have a good record on prisoners and crime. The chance of being a victim of crime is at its lowest level for 25 years and more offenders are being brought to justice. Reoffending rates have also fallen significantly, but we face real challenges that we must address as part of our work on prisons. Members have raised the question of prison numbers and how we can address reoffending. The hon. Member for Cambridge raised the important issue of who we put in prison and whether we need to consider reoffending in a new way. The hon. Member for The Wrekin (Mark Pritchard) also raised the key issues of foreign national prisoners and the need to protect and support our prison staff.
	I certainly echo the tributes paid by the hon. and learned Member for Harborough to the important work done by prison staff. He also drew attention to the need to support that work and to protect the safety of staff. That is why I take exception to the points made by the hon. Member for Arundel and South Downs when he accused staff of simply warehousing prisoners. That is not the case, nor is it part of our overall plan to tackle offending and reoffending.
	My right hon. Friend the Member for Knowsley, North and Sefton, East mentioned the need to consider sentencing balance, and he set out an important set of principles and topics for discussion. He said that he had not yet reached conclusions, and my right hon. Friend the Secretary of State and I give a commitment to consider his conclusions positively when they are produced.
	The issue of prison places was central to the debate. We provided 1,700 new prison places last year, and 2,422 to June this year. When the hon. Member for Arundel and South Downs says that the Labour Government have failed on prison places, I remind him of the fact that since March 1,240 prison places have been delivered. When he goes, as I hope he will, to visit Stoke Heath, Erlestoke, Albany, Send, Ranby, Lewes, Portland, Stocken, High Down, Blundeston, Wandsworth, Brinsford, Acklington, Kirklevington Grange and Wayland, he will see new prison places tackling the new prisoners who are coming in to those places because we are bringing more offences to justice. I hope we will bring forward more prison places before the end of the year.
	The difference between the Opposition and the Government is that we have put £1.2 billion of new money from taxpayers' resources into the system in this comprehensive spending review settlement. We will put in a potential further £1 billion plus in the next comprehensive spending review—money that I venture to suggest the hon. Member for Arundel and South Downs would rather put into tax cuts for than into public spending and public services.
	Important issues about preventing reoffending were mentioned by the hon. Member for Cambridge and others. It is important that, as the hon. Member for Woking suggested, we look at what we do about drugs and drug dependency. It is important that we do that in the community through better use of community sentences, and that we invest in services in relation to drugs in prison. The hon. Member for Monmouth mentioned drugs in prison, too, and I remind the House that Mr. Blakey, a former member of Her Majesty's inspectorate of constabulary, has produced a report for my right hon. Friend the Secretary of State on drugs in prison, which we intend to publish shortly. It considers how we can improve the regime in prisons and the community.
	The question of employment and raising the levels of literacy and skills was mentioned by the hon. Member for Cambridge and is absolutely vital. It is not just about putting people in prison for punishment, although punishment is extremely important but was lacking in the hon. Gentleman's speech. It is equally important what we do with people when they are in our system.
	We certainly have to do more work on education, raising literacy and numeracy and securing support for employment and training. That was why I was particularly keen only last week to join my hon. Friend the Member for Tooting (Mr. Khan), the Government Whip on the Bench today, in a visit to Wandsworth prison where we saw key examples of training in computers, literacy and cabling. We are working with private sector employers from outside Wandsworth prison and with the Under-Secretary of State for Innovation, Universities and Skills, my hon. Friend the Member for Tottenham (Mr. Lammy), who is also on the Front Bench today, to look at how we can link employers outside prison with offenders in prison to raise their skill levels, get them into employment and ensure that they have the opportunity to change their lives on their exit from the prison system.
	As was mentioned, we also need to look at whom we put in prison. Members will know that we have commissioned my noble Friend Lord Bradley to look at the issue of mental health. He will be reporting shortly to the Under-Secretary of State for Justice, my hon. Friend the Member for Liverpool, Garston (Maria Eagle), the Secretary of State and me on the question of mental health interventions and whether or not we can find alternatives to prison for certain prisoners who have mental health issues. We are also putting in place a range of provisions to consider cognitive behaviour programmes and the need for offenders to complete additional work on those issues.
	The hon. Member for Woking also mentioned the important issue of knife crime. I take his points extremely seriously. He will know that we have doubled the maximum prison sentence for possessing a knife in a public place to four years and that we have given school staff extra powers to search pupils for weapons. We have banned samurai swords and supported increased stop-and-search powers for police. Indeed, with my right hon. Friend the Home Secretary we have recently introduced 100 portable knife arches and 400 search wands. Knife crime is a serious issue. It does not affect every community in the UK, but those that are affected are affected very seriously. I take very seriously the hon. Gentleman's points about what we need to do.
	The Labour Government are providing the resources for extra prison places, tackling reoffending and making sure that we reduce crime, as we have done over the past 11 years. I challenge the Conservative Front Benchers to ensure that if their party formed a Government, it would provide the necessary resources. It would not do so; it would not tackle reoffending, as we are doing. I commend the Government amendment to the House and oppose the Opposition motion.

Ian Liddell-Grainger: I thank the hon. Gentleman—that councillor's name is Paul Buchanan. As Liberal Democrats go, he has the sharpest of brains. He was on the ISiS project, he worked with Jenny Hastings and he knows where all the bodies are buried. He has made no secret of the fact that Alan Jones would be out if he became leader, which he was destined to do. Unfortunately, that claim may have been a bit of an error. Last April, Alan Jones reported Paul Buchanan to the Standards Board for England—no fewer than 50 different trumped-up charges were made against the man.
	I sit on the Select Committee on Public Administration, but I am afraid that I do not have a high opinion of the Standards Board for England. The Government's motives for creating it were sound, and rightly so. After all, we must expect high standards of all our elected councillors and elected representatives. However, the Standards Board system allows injustice.
	Alan Jones was able to make those absurd complaints, and because of the way the board is set up, it is obliged to take them seriously, regardless of their nature. As a direct result, Jones silenced his most powerful internal critic. Suddenly, anything and everything that Councillor Paul Buchanan might have been able to say fell under the cloak of sub judice. That scuppered his political chances as well—conveniently. Irrespective of political persuasion, nobody wants a new leader with a shadow of an investigation hanging over him, so the Liberal Democrats ditched their best man, and little Mr. Jones must have relished every second of it.
	The original 50 charges, incidentally, were rejected very quickly indeed, but Jones, as usual, came back with fresh new charges. Inexcusably, the Standards Board is still wading through them. This dreadful system has permitted a brutal injustice in order to protect a dangerous unelected megalomaniac as he pursues the goal of a high-risk and very dangerous private partnership.
	I am now in a position to prove that one high-level official in county hall acted in support of the chief executive and gave false testimony to the Standards Board. The Secretary of State said in March, and the Minister repeated it in my Westminster Hall debate, that I should take up my concerns with the district auditor. I thank the Minister for that advice; I have done so. However, I am sad to report that the district auditor considers my evidence outside the strict remit of his accountancy, so I have no option other than to call in the Serious Fraud Office.
	I am also concerned about the involvement of the Avon and Somerset police in all this. Alan Jones hired the wife of the chief constable to negotiate directly with the preferred bidder, IBM. Now the chief constable himself has the right to sit on the board. I believe that that is too close for comfort and sets a dangerous precedent. Mr. Jones is now beginning to admit some of the ghastly truth about this deal. It will lead to job cuts. Even the police—Avon and Somerset constabulary—are talking seriously of shunting and shredding the front-line office staff in 19 police stations across the force area. The Minister is based in Gloucestershire and I am sure that he would have something to say if his police force were affected.
	Southwest One is currently trying to drum up extra trade in Essex, Torbay, Plymouth and Cornwall. Cornwall is becoming a unitary authority and I would say to that council, "Please look carefully at what you are doing; you are being led by the nose; if you go down this line, your expenses, accounts and accountability will be given to IBM based in Southampton". The same goes for Plymouth. They are both good councils; both need, dare I say it, guidance away from this mad scheme. I think that they should be afraid; they should be very, very afraid.
	The ethos of Southwest One is cut-price. The figures do not add up because there are no figures to see. If the other authorities sign up, they will be recklessly risking public money, but this is the way that IBM likes to do business: cutting margins, cheeseparing, getting less for more. The more it makes, the more it takes. Remember that IBM owns 75 per cent. of the action. New software arrives soon; it is called "SAP", but everywhere SAP has been sold to local government, there have been huge operational problems and big costly overspends. That has happened in Bradford, it is about to happen in Somerset and we are going to pay through the nose for it as taxpayers and as local people.
	IBM put in the Rural Payments Agency computers, but we would have been better off with a bag of kiddies' counting beans than with the mess that was made there. I do not blame the Government; I blame the systems. IBM lost the Department for Transport £970 million—do not take my word for it; the National Audit Office nailed it a couple of weeks ago. IBM cares about only one client—IBM—but that is business, is it not? One has to be tough to flourish and picking a global partner requires similar expertise to be able to counter and understand what is happening. That is what is missing, and that is what I want to address.
	Councillors in Somerset have had to rely on reports from a small group of officers, unaccountable to anyone, whose future careers are entwined with Southwest One. Councillors have found it incredibly difficult to represent the public interest because they are not getting impartial advice.
	I have a handful of positive suggestions for the Minister to consider. When it comes to Government projects, it is mandatory for the 4Ps agency to do regular reviews. Why not extend that to local government? Just an idea. How about beefing up the Audit Commission so that it can handle these highly complex deals? Either that or allow the National Audit Office to do the job, which would of course come under the Select Committees of this House. Specialist training for councillors on scrutiny committees would be welcome. They could learn about, and hopefully understand, what they ought to be looking for. Please, can we have clear Government guidance on the use of the magical cover-up phrase "commercial confidentiality"? In Somerset, that phrase has been used time and time again to explain away unnecessary secrecy. It is the motto of the county now. It has dropped whatever it used to be and it is now "Commercial confidentiality". It is used at every turn. Finally, a good deal is only as good as the cost and benefit realisation plan. We must have a mandatory standard.
	I am trying to be constructive for the future because I believe that, in Somerset at least, the project has been a complete disaster. Wool has been pulled over the eyes of the elected councillors and Alan Jones is clicking away with his knitting needles. I have been challenged to go and look at the contract. I have offered to take two forensic accountants, one business lawyer, Sir John Banham if he will come—I hope that he will—and possibly a couple of other people to help me. It will take six to seven days to go through it. However, I will not be allowed to see the whole contract or the whole business plan. I will not be allowed to see the correspondence on what made the deal possible and why the group was chosen over British Telecom and Capita. It is joke. It is a sham. The group is hiding. Why?
	The unions have been ignored and a cover-up has been the order of the day. It is, I am afraid—I say this gently—no good for the Minister to say that this is a matter for the councils concerned. It has moved on from there. I am afraid that it is no good telling me anymore that the district auditor is the person to go to. We have brought the matter up with the Minister and in business questions already.
	Somerset's crisis today is going to be someone else's tomorrow, without a shadow of a doubt. We need ministerial intervention, and I am afraid, to put it crudely, we need it pretty darn quick before the disaster gets worse.

Parmjit Dhanda: Not for the first time—for the second, I think—I am left somewhat breathless in a debate with the hon. Member for Bridgwater (Mr. Liddell-Grainger). He speaks with passion about the issue. If he carries on at this rate, the Parliament channel will be competing with the "The Apprentice" and other programmes for viewing figures.
	The hon. Gentleman is right about my response: it will be similar to the debate in March. I know that he is anticipating that in my comments about the role of the district auditor. If he has serious allegations to make about corruption, then he has made his views clear in no uncertain terms about the chief executive of Somerset county council and the chief constable of the constabulary. He did that in the previous Adjournment debate on 26 March and has used his parliamentary privilege to do so again today. As I said, the district auditor and the Serious Fraud Office are the places for him to go. He has indicated that that is what he intends to do.
	I congratulate the hon. Gentleman on securing this second debate on an issue that is fundamentally about Government PFI contracts. He has made it clear that he does not have a problem with PFI or with partnerships as a whole.
	I began my response to the debate in March with a warning, and I feel that I should do so again. It is important to recognise that although local authorities are increasingly strong and independent bodies, they are ultimately accountable to local residents, and must ensure that they act in a professional and responsible manner. Clearly there has been a breakdown in their relations with Members of Parliament—certainly with the hon. Member for Bridgwater—but ideally they should have a good rapport with MPs as well. I have run-ins with my own local authorities, for these things do not always run smoothly, but in an ideal world that would be the case.
	In particular, local authorities are responsible for the proper administration of their own financial records within the framework set by legislation—including the duty of best value and public procurement law—and codes of practice issued by professional bodies such as the Chartered Institute of Public Finance and Accountancy. For that reason, the specific questions raised by the hon. Gentleman can only be answered directly by Southwest One and by Somerset county council, Taunton Deane borough council and Avon and Somerset constabulary.
	As I have said, if the hon. Gentleman has specific evidence of financial irregularities or a failure to follow due process in the establishment of the Southwest One partnership, he should present it to the district auditor. I am well aware that he has already done that to some extent. The district auditor is the right person to investigate such matters. If the hon. Gentleman has more serious allegations of corruption, they should be presented to the Serious Fraud Office. I realise from what he has said tonight that he feels somewhat fettered, and does not feel able to speak to the local constabulary, because part of his issue is with them in the first place.
	Central Government cannot and, in my view, should not be involved in every action that councils take, and I think it right that neither Ministers nor officials have been involved in the development of the Southwest One partnership. However, owing to the hon. Gentleman's obvious concern about this project—not least that expressed in the debate in March—the Department has made inquiries of the Audit Commission and Somerset county council. I have to say that, so far, no evidence of wrongdoing has been presented to or uncovered by either the auditors or the police.
	Two auditors have been involved in reviewing the work to establish Southwest One. The Audit Commission appointed Grant Thornton to act as external auditor in 2006-07, and from 2007-08, the Commission itself has acted as external auditor. Both auditors recently reported to Somerset county council, and I should say in fairness to them that they have been broadly positive about the processes that they followed. Grant Thornton summarised their opinions as follows:
	"Given the size and complexity of the contract, it is inevitable that there are some areas of the process where improvement could have been made, but overall our review found that arrangements were sufficiently robust to give us assurance."
	The Audit Commission has presented outline findings in similar terms, stating that there was a reasonable process for procurement with planned improved outcomes for the council, that there were appropriate reporting and staffing arrangements, and that the deal had been market-tested and improved through negotiation. The Audit Commission points out that considerable service and financial challenges remain—I know that the hon. Gentleman agrees with that—and the council needs to invest properly in the management of the contracts. In a project of this size, that is not surprising, but I hope that the partners in Southwest One will take on board the conclusions and redouble their efforts and prove this project a success.
	Both in this debate and when the hon. Gentleman spoke to me earlier this evening, he mentioned his concern about jobs; he fears that 5,000 jobs may be lost under some kind of redundancy scheme. However, in fairness to the hon. Gentleman—and also the local authority—he did make it clear that the county council has changed its position on that, and is now saying that any changes would be due to "natural wastage"; those are his words, not mine. Accountability for all these measures is ultimately through the ballot box at local level. Local authorities have to be able to demonstrate best value to their residents, but also, in an ideal world, work in partnership with local Members of Parliament.
	In broader terms on commissioning, procurement and shared services, central Government can—and do—facilitate the sharing of experience and expertise so that councils can make the most of the opportunities for more efficient and effective service delivery that are available through partnership with the private sector, the third sector, or other parts of the public sector. The hon. Gentleman was generous in his praise of the Government, and of the guidance and the work being done to support local authorities on that path.
	Many authorities are already benefiting from having entered partnerships: more than half of all councils say that they are engaged in, or are considering entering into, a service partnership, and that they expect to obtain savings of up to 15 per cent. as a result—savings not to be sniffed at. Let me cite as an example a partnership involving one local authority that covers customer services, revenue and benefits, property services, ICT and human resources. That has generated a variety of benefits, in this case including 12 per cent. cost savings on the services transferred, and improved service delivery such as better council tax and national non-domestic rate collection rates. Those are some of the advantages that can be gained through better partnership working.